Download PDF
Aktuelle Rheumatologie 2019; 44(06): 383-391
DOI: 10.1055/a-1041-4093
Übersichtsarbeit
© Georg Thieme Verlag KG Stuttgart · New York

Rehabilitation von Patienten mit entzündlich-rheumatischen Erkrankungen

Informationen und Empfehlungen der Projektgruppe Rehabilitation des Regionalen Kooperativen Rheumazentrums Niedersachsen e.V.Rehabilitation of Patients with Rheumatic DiseasesInformation and recommendations of the project group “Rehabilitation des Regionalen Kooperativen Rheumazentrums Niedersachsen e.V.”
Dirk Meyer-Olson
1   Abteilung Rheumatologie/ Innere Medizin, m&i Fachklinik Bad Pyrmont, Bad Pyrmont
,
Kirsten Hoeper
2   Regionales Kooperatives Rheumazentrum Niedersachsen e.V., Hannover
,
Christian Sturm
3   Klinik für Rehabilitationsmedizin, Medizinische Hochschule Hannover, Hannover
,
Thilo Busche
4   Median Ambulantes Gesundheitszentrum Hannover, Hannover
,
Wolfgang Brückle
5   Rheumatologikum Hannover, Hannover
,
Karin Roth
5   Rheumatologikum Hannover, Hannover
,
Sigrid Mattussek
6   Regionales Kooperatives Rheumazentrum Niedersachsen e.V, Hannover
,
Christoph Gutenbrunner
3   Klinik für Rehabilitationsmedizin, Medizinische Hochschule Hannover, Hannover
,
Uwe Polnau
7   Ärztlicher Dienst, Rehazentrum Bad Eilsen, Bad Eilsen
› Author Affiliations
Further Information

Publication History

Publication Date:
05 December 2019 (online)

Also available at
    Permissions and Reprints

Zusammenfassung

Die rheumatologische Rehabilitation dient der Wiederherstellung einer eingeschränkten sozialen oder beruflichen Teilhabe bei Patienten mit entzündlich rheumatologischen Erkrankungen. Trotz deutlicher Fortschritte bei der medikamentösen Versorgung von Patienten mit entzündlich-rheumatischen Erkrankungen, insbesondere bei der rheumatoiden Arthritis und der Spondyloarthritis, finden sich trotz Verbesserungen weiterhin noch deutliche Einschränkungen der beruflichen Teilhabe bei Patienten mit diesen Krankheitsbildern. Dieser Übersichtartikel vermittelt den aktuellen Stand der rheumatologischen Rehabilitation in Deutschland und beschreibt aktuelle Problemfelder der rehabilitationsmedizinischen Versorgung sowie mögliche Lösungsansätze.

Abstract

The main aim of rehabilitation in patients with rheumatic diseases is the restoration of social or vocational participation. Although substantial improvements have been achieved in the medical management of rheumatic diseases such as rheumatoid arthritis and spondyloarthritis, rheumatic patients continue to face substantial limitations in vocational participation. This review summarises the current knowledge on rehabilitation in rheumatic diseases in Germany, including its current problems as well as potential strategies for solution.

Schlüsselwörter

rheumatoide Arthritis - Spondylarthritis - Arbeitsunfähigkeit - berufliche Rehabilitation

Key words

rheumatoid arthritis - spondyloarthritis - work disability - vocational rehabilitation
 

  • Literatur

  • 1 Zink A, Albrecht K. How frequent are musculoskeletal diseases in Germany?. Z Rheumatol 2016; 75: 346-353. doi:10.1007/s00393-016-0094-2
    CrossrefPubMedGoogle Scholar
  • 2 Albrecht K, Huscher D, Eidner T. et al. Medical treatment of rheumatoid arthritis in 2014 : Current data from the German Collaborative Arthritis Centers. Z Rheumatol 2016; DOI: 10.1007/s00393-016-0156-5.. doi:10.1007/s00393-016-0156-5
    CrossrefPubMedGoogle Scholar
  • 3 Albrecht K, Luque Ramos A, Callhoff J. et al. Outpatient care and disease burden of rheumatoid arthritis : Results of a linkage of claims data and a survey of insured persons. Z Rheumatol 2018; 77: 102-112 doi:10.1007/s00393-017-0294-4
    CrossrefPubMedGoogle Scholar
  • 4 [Anonym] World Health Organization: Health topics: Rehabilitation. In.
    PubMed
  • 5 [Anonym] International classification of functioning, disability and health : ICF.: World Health Organization. 2001;
    PubMed
  • 6 Braun J, Zochling J, Grill E. et al. International classification of functioning, disability and health and its significance for rheumatology. Z Rheumatol 2007; 66: 603-606, 608–610 doi:10.1007/s00393-007-0188-y
    CrossrefPubMedGoogle Scholar
  • 7 Buschmann-Steinhage R, Bruggemann S. Changes in medical rehabilitation of the German Statutory Pension Insurance Scheme. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2011; 54: 404-410. doi:10.1007/s00103-011-1240-2
    CrossrefPubMedGoogle Scholar
  • 8 DALYs GBD, Collaborators H. Global, regional, and national disability-adjusted life-years (DALYs) for 333 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet 2017; 390: 1260-1344. doi:10.1016/S0140-6736(17)32130-X
    CrossrefPubMedGoogle Scholar
  • 9 Poppelaars PB, van Tuyl LHD, Boers M. Normal mortality of the COBRA early rheumatoid arthritis trial cohort after 23 years of follow-up. Ann Rheum Dis 2019; 78: 586-589. doi:10.1136/annrheumdis-2018-214618
    CrossrefPubMedGoogle Scholar
  • 10 Mau W, Beyer W, Ehlebracht-Konig I. et al. Treat to participation : Position paper of the German Society for Rheumatology on sustained improvement of functional health of patients with rheumatic and musculoskeletal diseases. Z Rheumatol 2015; 74: 553-557 doi:10.1007/s00393-015-1640-z
    CrossrefPubMedGoogle Scholar
  • 11 Graf R, Löhr J, Wirth CJ. Medical rehabilitation of patients with chronic polyarthritis or spinal arthritis. Information and recommendations of the Rehabilitation Project Group of the Hannover Regional Cooperative Rheumatoid Arthritis Center e.V. Orthopade 2000; 29: 994-998
    CrossrefPubMedGoogle Scholar
  • 12 Geuskens GA, Burdorf A, Hazes JM. Consequences of rheumatoid arthritis for performance of social roles--a literature review. J Rheumatol 2007; 34: 1248-1260
    PubMedGoogle Scholar
  • 13 Sokka T. Work disability in early rheumatoid arthritis. Clin Exp Rheumatol 2003; 21: S71-S74
    PubMedGoogle Scholar
  • 14 Lenssinck ML, Burdorf A, Boonen A. et al. Consequences of inflammatory arthritis for workplace productivity loss and sick leave: a systematic review. Ann Rheum Dis 2013; 72: 493-505. doi:10.1136/annrheumdis-2012-201998
    CrossrefPubMedGoogle Scholar
  • 15 Cakar E, Taskaynatan MA, Dincer U. et al. Work disability in ankylosing spondylitis: differences among working and work-disabled patients. Clin Rheumatol 2009; 28: 1309-1314 doi:10.1007/s10067-009-1249-1
    CrossrefPubMedGoogle Scholar
  • 16 Boonen A, Brinkhuizen T, Landewe R. et al. Impact of ankylosing spondylitis on sick leave, presenteeism and unpaid productivity, and estimation of the societal cost. Ann Rheum Dis 2010; 69: 1123-1128. doi:10.1136/ard.2009.116764
    CrossrefPubMedGoogle Scholar
  • 17 Krishnan E, Lingala B, Bruce B. et al. Disability in rheumatoid arthritis in the era of biological treatments. Ann Rheum Dis 2012; 71: 213-218 doi:10.1136/annrheumdis-2011-200354
    CrossrefPubMedGoogle Scholar
  • 18 Mau W, Bornmann M, Weber H. et al. Prediction of permanent work disability in a follow-up study of early rheumatoid arthritis: results of a tree structured analysis using RECPAM. Br J Rheumatol 1996; 35: 652-659
    CrossrefPubMedGoogle Scholar
  • 19 Merkesdal S, Ruof J, Mittendorf T. et al. Indirect medical costs in the first 3 years of rheumatoid arthritis: comparison of current methodological approaches. Expert Rev Pharmacoecon Outcomes Res 2002; 2: 313-318 doi:10.1586/14737167.2.4.313
    CrossrefPubMedGoogle Scholar
  • 20 Castillo-Ortiz JD, Ramiro S, Landewe R. et al. Work Outcome in Patients With Ankylosing Spondylitis: Results From a 12-Year Followup of an International Study. Arthritis Care Res (Hoboken) 2016; 68: 544-552. doi:10.1002/acr.22730
    PubMedGoogle Scholar
  • 21 Merkesdal S, Huelsemann JL, Mittendorf T. et al. Productivity costs of rheumatoid arthritis in Germany. Cost composition and prediction of main cost components. Z Rheumatol 2006; 65: 527-534 doi:10.1007/s00393-005-0024-1
    CrossrefPubMedGoogle Scholar
  • 22 Huscher D, Merkesdal S, Thiele K. et al. Cost of illness in rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis and systemic lupus erythematosus in Germany. Ann Rheum Dis 2006; 65: 1175-1183 doi:10.1136/ard.2005.046367
    CrossrefPubMedGoogle Scholar
  • 23 Batko B, Rolska-Wojcik P, Wladysiuk M. Indirect Costs of Rheumatoid Arthritis Depending on Type of Treatment-A Systematic Literature Review. Int J Environ Res Public Health 2019; 16. doi:10.3390/ijerph16162966
    PubMedGoogle Scholar
  • 24 Husberg M, Bernfort L, Hallert E. Costs and disease activity in early rheumatoid arthritis in 1996-2000 and 2006-2011, improved outcome and shift in distribution of costs: a two-year follow-up. Scand J Rheumatol 2018; 47: 378-383. doi:10.1080/03009742.2017.1420224
    CrossrefPubMedGoogle Scholar
  • 25 Kalkan A, Hallert E, Bernfort L. et al. Costs of rheumatoid arthritis during the period 1990-2010: a register-based cost-of-illness study in Sweden. Rheumatology (Oxford) 2014; 53: 153-160 doi:10.1093/rheumatology/ket290
    CrossrefPubMedGoogle Scholar
  • 26 Mau W, Thiele K, Lamprecht J. Trends of work force participation of patients with rheumatic diseases : results from German social insurance data and the national database of the German collaborative arthritis centers. Z Rheumatol 2014; 73: 11-19. doi:10.1007/s00393-013-1205-y
    CrossrefPubMedGoogle Scholar
  • 27 Brauer W, Merkesdal S, Mau W. Long-term follow-up and prognosis of work capacity in the early stage of chronic polyarthritis. Z Rheumatol 2002; 61: 426-434
    CrossrefPubMedGoogle Scholar
  • 28 Doeglas D, Suurmeijer T, Krol B. et al. Work disability in early rheumatoid arthritis. Ann Rheum Dis 1995; 54: 455-460 doi:10.1136/ard.54.6.455
    CrossrefPubMedGoogle Scholar
  • 29 Young A, Dixey J, Kulinskaya E. et al. Which patients stop working because of rheumatoid arthritis? Results of five yearsʼ follow up in 732 patients from the Early RA Study (ERAS). Ann Rheum Dis 2002; 61: 335-340 doi:10.1136/ard.61.4.335
    CrossrefPubMedGoogle Scholar
  • 30 Rodrigues Manica S, Sepriano A, Ramiro S. et al. Work participation in spondyloarthritis across countries: analysis from the ASAS-COMOSPA study. Ann Rheum Dis 2018; 77: 1303-1310 doi:10.1136/annrheumdis-2018-213464
    CrossrefPubMedGoogle Scholar
  • 31 Mau W, Beyer W, Ehlebracht-Konig I. et al. Trends in rehabilitation of patients with rheumatic diseases in Germany. Z Rheumatol 2014; 73: 139-148 doi:10.1007/s00393-013-1259-x
    CrossrefPubMedGoogle Scholar
  • 32 Schubert M, Fiala K, Grundke S. et al. Der Zugang zu medizinischer Rehabilitation aus Perspektive niedergelassener Ärzte – Probleme und Optimierungsmöglichkeiten. Phys Med Rehab Kuror 2012; 22: 264-270 doi:10.1055/s-0032-1314882
    Article in Thieme ConnectPubMedGoogle Scholar
  • 33 Gilworth G, Haigh R, Tennant A. et al. Do rheumatologists recognize their patientsʼ work-related problems?. Rheumatology (Oxford) 2001; 40: 1206-1210. doi:10.1093/rheumatology/40.11.1206
    CrossrefPubMedGoogle Scholar
  • 34 de Buck PD, van Amstel RJ, Buijs PC. et al. Communication between Dutch rheumatologists and occupational physicians in the occupational rehabilitation of patients with rheumatic diseases. Ann Rheum Dis 2002; 61: 62-65. doi:10.1136/ard.61.1.62
    CrossrefPubMedGoogle Scholar
  • 35 Drambyan Y, Parthier K. Preservation of ability to work and securing vocational participation: non-pharmaceutical support options for rheumatologists. Z Rheumatol 2014; 73: 20-26. doi:10.1007/s00393-013-1206-x
    PubMedGoogle Scholar
  • 36 [Anonym] Reha-Prozess: Bundesarbeitsgemeinschaft für Rehabilitation (BAR) e.V.; 2019
    PubMed
  • 37 Grotle M, Klokkerud M, Kjeken I. et al. Whatʼs in the black box of arthritis rehabilitation? A comparison of rehabilitation practice for patients with inflammatory arthritis in northern Europe. J Rehabil Med 2013; 45: 458-466 doi:10.2340/16501977-1125
    CrossrefPubMedGoogle Scholar
  • 38 Putrik P, Ramiro S, Guillemin F. et al. Patients with rheumatoid arthritis facing sick leave or work disability meet varying regulations: a study among rheumatologists and patients from 44 European countries. Ann Rheum Dis 2019; DOI: 10.1136/annrheumdis-2019-215294.. doi:10.1136/annrheumdis-2019-215294
    CrossrefPubMedGoogle Scholar
  • 39 van der Zee-Neuen A, Putrik P, Ramiro S. et al. Large country differences in work outcomes in patients with RA - an analysis in the multinational study COMORA. Arthritis Res Ther 2017; 19: 216 doi:10.1186/s13075-017-1421-y
    CrossrefPubMedGoogle Scholar
  • 40 Bethge M. Rehabilitation and work participation. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2017; 60: 427-435 doi:10.1007/s00103-017-2519-8
    CrossrefPubMedGoogle Scholar
  • 41 [Anonym]. Medizinisch-beruflich orientierte Rehabilitation. 4. Auflage Aufl: Deutsche Rentenversicherung Bund; 2015
    Google Scholar
  • 42 Mau W, Ehlebracht-Konig I. Rehabilitation in axial spondyloarthritides. Rehabilitation (Stuttg) 2013; 52: 51-62 doi:10.1055/s-0032-1305165
    Article in Thieme ConnectPubMedGoogle Scholar
  • 43 de Buck PD, Breedveld J, van der Giesen FJ. et al. A multidisciplinary job retention vocational rehabilitation programme for patients with chronic rheumatic diseases: patientsʼ and occupational physiciansʼ satisfaction. Ann Rheum Dis 2004; 63: 562-568. doi:10.1136/ard.2003.007260
    CrossrefPubMedGoogle Scholar
  • 44 Vlieland TP, de Buck PD, van den Hout WB. Vocational rehabilitation programs for individuals with chronic arthritis. Curr Opin Rheumatol 2009; 21: 183-188. doi:10.1097/BOR.0b013e328324e6eb
    CrossrefPubMedGoogle Scholar
  • 45 Steultjens EM, Dekker J, Bouter LM. et al. Occupational therapy for rheumatoid arthritis. Cochrane Database Syst Rev 2004; doi:10.1002/14651858.CD003114.pub2: CD003114. DOI: 10.1002/14651858.CD003114.pub2.
    CrossrefPubMedGoogle Scholar
  • 46 Keysor JJ, LaValley MP, Brown C. et al. Efficacy of a Work Disability Prevention Program for People with Rheumatic and Musculoskeletal Conditions: A Single-Blind Parallel-Arm Randomized Controlled Trial. Arthritis Care Res (Hoboken) 2018; 70: 1022-1029. doi:10.1002/acr.23423
    PubMedGoogle Scholar
  • 47 Kjeken I, Bo I, Ronningen A. et al. A three-week multidisciplinary in-patient rehabilitation programme had positive long-term effects in patients with ankylosing spondylitis: randomized controlled trial. J Rehabil Med 2013; 45: 260-267 doi:10.2340/16501977-1078
    CrossrefPubMedGoogle Scholar
  • 48 [Anonym] Qualitätssicherung nach § 37 Abs. 1 SGB IX -Gemeinsame Empfehlung: Bundesarbeitsgemeinschaft für Rehabilitation (BAR) e.V.; 2018
    PubMed
  • 49 Klokkerud M, Hagen KB, Kjeken I. et al. Development of a framework identifying domains and elements of importance for arthritis rehabilitation. J Rehabil Med 2012; 44: 406-413 doi:10.2340/16501977-0961
    CrossrefPubMedGoogle Scholar
  • 50 Zink A, Braun J, Gromnica-Ihle E. et al. Memorandum of the German Society for Rheumatology on the quality of treatment in rheumatology – Update 2016. Z Rheumatol 2017; 76: 195-207 doi:10.1007/s00393-017-0297-1
    CrossrefPubMedGoogle Scholar