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Physikalische Medizin, Rehabilitationsmedizin, Kurortmedizin 2011; 21(6): 297-310
DOI: 10.1055/s-0031-1276996
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© Georg Thieme Verlag KG Stuttgart · New York

Rehabilitation von Patienten mit rheumatoider Arthritis

Rehabilitation of Patients with Rheumatoid ArthritisK.  Kerschan-Schindl1 , K.  Machold2
  • 1Universitätsklinik für Physikalische Medizin und Rehabilitation, MUW, AKH Wien, Österreich
  • 2Universitätsklinik für Innere Medizin III, Klinische Abteilung für Rheumatologie, MUW, AKH Wien, Österreich
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Publication History

Publication Date:
19 December 2011 (online)

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Rehabilitation von Patienten mit rheumatoider ArthritisInnere Medizin up2date 2013; 01(01): 39-54
DOI: 10.1055/s-0032-1326382

Zusammenfassung

Die rheumatoide Arthritis (RA) ist eine chronische, entzündliche Gelenkerkrankung, welche mit Gelenkschmerz, -schwellung und -destruktion einhergeht. Neben genetischen Faktoren scheint auch der Lebensstil des Betroffenen einen Einfluss auf die Entstehung der Krankheit zu haben. Da die Klassifizierung mithilfe der klassischen ACR-Kriterien (ACR: American College of Rheumatology) nur für chronifizierte Formen der RA geeignet, allerdings eine möglichst frühzeitige medikamentöse Therapie das Ziel ist, wurden nun speziell zur Klassifizierung der Früharthritis die neuen ACR- / EULAR-Klassifikationskriterien (EULAR: European League Against Rheumatism) entwickelt. Die krankheitsspezifische Medikation hat sich sehr verbessert; dennoch sind Patienten, die an einer RA leiden, infolge der chronischen Entzündungen häufig in den Bereichen körperliche Struktur und Funktion, Aktivitäten und Partizipation eingeschränkt. Mittels der internationalen Klassifizierung der funktionalen Gesundheit (ICF) können diese Probleme des Betroffenen erfasst werden. Dies ist Voraussetzung für eine komplexe, durch ein multidisziplinäres Team durchgeführte, Rehabilitation. Die therapeutischen Ansätze der Rehabilitation umfassen die Übungs- und Trainingstherapie, Ergotherapie, physikalische Modalitäten, psychologische Betreuung und diätische Maßnahmen. Ein solches Rehabilitationsprogramm sollte individuell angepasst werden, um die Funktion und Selbstständigkeit des Patienten möglichst lange zu erhalten.

Abstract

Rheumatoid arthritis (RA) is a chronic inflammatory disease characterised by joint swelling, joint tenderness and joint destruction, leading to severe disability and premature mortality. RA is considered an autoimmune disease, however, lifestyle factors also influence the clinical manifestation of the disease. The ACR (American College of Rheumatology)-classification criteria have a significant limitation in discriminating patients suffering of early RA. To be able to treat these patients as soon as possible, the new ACR / EULAR- (European League Against Rheumatism-) classification criteria were developed. Despite medical treatment RA-patients often have deficits in body structure and function, activities, and participation. The international classification of functioning, disability and health (ICF) comprehensive core set for rheumatoid arthritis helps to assess patients’ daily functioning and to plan a complex rehabilitation performed by a multidisciplinary team. Non-pharmacologic therapeutic options include exercise, occupational therapy, different physical modalities, psychologic care, and special diets. Such a rehabilitation program has to be individualised to optimise the effect and to conserve the patient’s function and independence as long as possible.

Schlüsselwörter

rheumatoide Arthritis - Rehabilitation - krankheitsspezifische Medikation - Übungs- und Trainingstherapie - physikalisch-therapeutische Modalitäten

Keywords

rheumatoid arthritis - rehabilitation - disease-specific medication - exercise - physical modalities

Literatur

  • 1 Lee D M, Weinblatt W E. Rheumatoid arthritis.  Lancet. 2001;  358 903-911
    Search in Google Scholar
  • 2 Myasoedova E, Crowson C S, Kremers H M et al. Is the incidence of rheumatoid arthritis rising?.  Arthritis & Rheumatism. 2010;  62 1576-1582
    Search in Google Scholar
  • 3 Scott D L, Wolfe F, Huizinga T W. Rheumatoid arthritis.  Lancet. 2010;  376 1094-1108
    Search in Google Scholar
  • 4 Kokkonen H, Söderström I, Hallmans G et al. Up-regulation of cytokines and chemokines predates the onset of rheumatoid arthritis.  Arthritis Rheum. 2010;  62 383-391
    Search in Google Scholar
  • 5 Arnett F C, Edworthy S M, Bloch D A et al. The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis.  Arthritis and Rheumatism. 1988;  31 315-324
    Search in Google Scholar
  • 6 Van Gaalen F A, Linn-Rasker S P, van Venrooij W J et al. Autoantibodies to cyclic citrullinated peptides predict progression to rheumatoid arthritis in patients with undifferentiated arthritis.  Arthritis & Rheumatism. 2004;  50 709-715
    Search in Google Scholar
  • 7 Aletaha D, Neogi T, Silman A J et al. Rheumatoid arthritis classification criteria: an American College of Rheumatology / European League Against Rheumatism collaborative initiative.  Ann Rheum Dis. 2010;  69 1580-1588
    Search in Google Scholar
  • 8 Prevoo M LL, van’T Hoff M A, Kuper H H et al. Modified disease activity scores that include twenty-eight-point counts, development and validation in a prospective longitudinal study of patients with rheumatoid arthritis.  Arthritis Rheum. 1995;  38 44-48
    Search in Google Scholar
  • 9 Smolen J S, Breedveld F C, Schiff M H et al. A simplified disease activity index for rheumatoid arthritis for use in clinical practice.  Rheumatology. 2003;  42 244-245
    Search in Google Scholar
  • 10 Aletaha D, Smolen J S. The Simplified Disease Activity Index (SDAI) and the Clinical Disease Activity Index (CDAI): A review of their usefulness and validity in rheumatoid arthritis.  Clin Exp Rheumatol. 2005;  23 S100-108
    Search in Google Scholar
  • 11 Steinbrocker O, Traeger C H, Battman R G. Therapeutic criteria in rheumatoid arthritis.  J Am Med Assoc. 1949;  140 659-662
    Search in Google Scholar
  • 12 Fries J F, Spitz P W, Young D Y. The dimensions of health outcomes: the health assessment questionnaire, disability and pain scales.  J Rheumatol. 1982;  9 789-793
    Search in Google Scholar
  • 13 Ware J E, Sherboume C D. The MOS 36-item Short-Form Health Survey (SF-36). I. Conceptual framework and item selection.  Med Care. 1992;  30 473-483
    Search in Google Scholar
  • 14 Smolen J S, Landewe R, Breedveld F C et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs.  Annals of the Rheumatic Diseases. 2010;  69 964-975
    Search in Google Scholar
  • 15 Hench P S, Kendall E C, Slocumb C H et al. The Effect of A Hormone of the Adrenal Cortex (17-Hydroxy-11-Dehydrocorticosterone – Compound-E) and of Pituitary Adrenocorticotrophic Hormone on Rheumatoid Arthritis – Preliminary Report.  Annals of the Rheumatic Diseases. 1949;  8 97-104
    Search in Google Scholar
  • 16 Kaiser H, Kley H K. Cortisontherapie: Corticoide in Klinik und Praxis.. Stuttgart, New York: Thieme; 2002. 11. Aufl
    Search in Google Scholar
  • 17 DVO-Leitlinie 2009 zur Prophylaxe, Diagnostik und Therapie der Osteoporose bei Erwachsenen.  http://www.dv-osteologie.org/uploads/leitlinien/DVO-Leitlinie%202009%20Langfassung_Druck.pdf Osteologie. 2009;  18 304-324
    Search in Google Scholar
  • 18 Stucki G, Cieza A, Geyh S et al. ICF core sets for rheumatoid arthritis.  J Rehabil Med. 2004;  44 (Suppl) 87-93
    Search in Google Scholar
  • 19 Stamm T A, Cieza A, Coenen M et al. Validating the international classification of functioning, disability, and health comprehensive core set for rheumatoid arthritis from the patient perspective: a qualitative study.  Arthritis Rheum. 2005;  15 431-439
    Search in Google Scholar
  • 20 Uhlig T, Lillemo S, Moe R H et al. Reliability of the ICF Core Set for rheumatoid arthritis.  Ann Rheum Dis. 2007;  66 1078-1094
    Search in Google Scholar
  • 21 Sullivan P W, Ghushchyan V, Huang X Y et al. Influence of rheumatoid arthritis on employment, function, and productivity in a nationally representative sample in the Unites States.  J Rheumatol. 2010;  37 544-549
    Search in Google Scholar
  • 22 Allaire S, Wolfe F, Niu J et al. Current risk factors for work disability associated with rheumatoid arthritis: recent data from a US national cohort.  Arthritis Rheum. 2009;  61 321-328
    Search in Google Scholar
  • 23 Gabriel S E, Crowson C S, Kremers H M et al. Survival in rheumatoid arthritis: a population-based analysis of trends over 40 years.  Arthritis Rheum. 2003;  48 54-58
    Search in Google Scholar
  • 24 Godha D, Shi L, Mavronicolas H. Association between tendency towards depression and severity of rheumatoid arthritis from a national representative sample: the Medical Expenditure Panel Survey.  Curr Med Res Opin. 2010;  26 1685-1690
    Search in Google Scholar
  • 25 Hagel S, Lindqvist E, Petersson I F et al. Validation of outcome measurement instruments used in a multidisciplinary rehabilitation intervention for patients with chronic inflammatory arthritis: linking to the international classification of functioning, disability and health, construct validity and responsiveness to change.  J Rehabil Med. 2011;  43 411-419
    Search in Google Scholar
  • 26 Chung K C, Burns P B, Reichert H A et al. Properties of the international classification for functioning, disability and health in assessing hand outcomes in patients with rheumatoid arthritis.  J Rehabil Med. 2011;  43 292-298
    Search in Google Scholar
  • 27 Wilcox S, Der Ananian C, Abbott J et al. Perceived exercise barriers, enablers, and benefits among exercising and nonexercising adults with arthritis: results from a quantitative study.  Arthritis Rheum. 2006;  55 616-627
    Search in Google Scholar
  • 28 Hayashibara M, Hagino H, Katagiri H et al. Incidence and risk factors of falling in ambulatory patients with rheumatoid arthritis: a prospective 1-year study.  Ost Int. 2010;  21 1825-1833
    Search in Google Scholar
  • 29 Van Staa T P, Geusens P, Bijlsma J W et al. Clinical assessment of the long-term risk of fracture in patients with rheumatoid arthritis.  Arthritis Rheum. 2006;  54 3104-3112
    Search in Google Scholar
  • 30 Roux C. Osteoporosis in inflammatory joint diseases.  Ost Int. 2011;  22 421-433
    Search in Google Scholar
  • 31 Solomon D H, Goodson N J, Katz J N et al. Patterns of cardiovascular risk in rheumatoid arthritis.  Ann Rheum Dis. 2006;  65 1608-1612
    Search in Google Scholar
  • 32 Baillet A, Zeboulon N, Gossec L et al. Efficacy of cardiorespiratory aerobic exercise in rheumatoid arthritis. Meta-analysis of randomized controlled trials.  Arthritis Care & Research. 2010;  62 984-992
    Search in Google Scholar
  • 33 Lemmey A B, Marcora S M, Chester K et al. Effects of high-intensity resistance training in patients with rheumatoid arthritis: A randomized controlled trial.  Arthritis & Rheumatism. 2009;  61 1726-1734
    Search in Google Scholar
  • 34 Hurkmans E, van der Giesen F J, Vliet Vlieland T PM et al. Dynamic exercise programs (aerobic capacity and/or muscle strength training) in patients with rheumatoid arthritis.  Cochrane Database of Systematic Reviews. 2009;  CD006853
    Search in Google Scholar
  • 35 De Jong Z, Munneke M, Zwinderman A H et al. Is a long-term high-intensity exercise program effective and safe in patients with rheumatoid arthritis? Results of a randomized controlled trial.  Arthritis and Rheumatism. 2003;  48 2415-2424
    Search in Google Scholar
  • 36 De Jong Z, Munneke M, Kroon H M et al. Long-term follow-up of a high-intensity exercise program in patients with rheumatoid arthritis.  Clin Rheumatol. 2009;  28 663-671
    Search in Google Scholar
  • 37 Van der Giesen F J, van Lankveld W, Hopman-Rock M et al. Exploring the public health impact of an intensive exercise program for patients with rheumatoid arthritis. A dissemination and implementation study.  Arthritis Care & Research. 2010;  62 865-872
    Search in Google Scholar
  • 38 Cairns A P, McVeigh J G. A systematic review of the effects of dynamic exercise in rheumatoid arthritis.  Rheumatol Int. 2009;  30 147-158
    Search in Google Scholar
  • 39 Neill J, Belan I, Ried K. Effectiveness of non-pharmacological interventions for fatigue in adults with multiple sclerosis, rheumatoid arthritis, or systemic lupus erythematosus: a systematic review.  J Advanced Nursing. 2006;  56 617-635
    Search in Google Scholar
  • 40 Silva K NG, Imoto A M, Almeida G JM et al. Balance training (proprioceptive training) for patients with rheumatoid arthrits.  Cochrane Database of Systematic Reviews. 2010;  CD007648
    Search in Google Scholar
  • 41 Han A, Judd M, Welch V et al. Tai Chi for treating rheumatoid arthritis.  Cochrane Database of Systematic Reviews. 2004;  CD004849
    Search in Google Scholar
  • 42 Lee M S, Pittler M H, Ernst E. Tai Chi for rheumatoid arthritis: a systematic review.  Rheumatology. 2007;  46 1648-1651
    Search in Google Scholar
  • 43 Cooney J K, Law R J, Matschke V et al. Benefits of exercise in rheumatoid arthritis. Review article.  SAGE-Hindawi Access to Research J Aging Research. 2011;  DOI: DOI: 10.4061/2011/681640
    Search in Google Scholar
  • 44 Steultjens E M, Dekker J, Bouter L M et al. Occupational therapy for rheumatoid arthritis.  Cochrane Database Syst Rev. 2004;  (1) CD003114
    Search in Google Scholar
  • 45 de Boer I G, Peeters A J, Ronday H K et al. Assistive devices: usage in patients with rheumatoid arthritis.  Clin Rheumatol. 2009;  28 119-128
    Search in Google Scholar
  • 46 Macedo A M, Oakley S P, Panayi G S et al. Functional and work outcomes improve in patients with rheumatoid arthritis who receive targeted, comprehensive occupational therapy.  Arthritis & Rheumatism. 2009;  61 1522-1530
    Search in Google Scholar
  • 47 Mathieux R, Marotte H, Battistine L et al. Early occupational therapy programme increases hand grip strength at 3 months: results from a randomised, blind, controlled study in early rheumatoid arthritis.  Ann Rheum Dis. 2009;  68 400-403
    Search in Google Scholar
  • 48 Egan M, Brosseau L, Farmer M et al. Splints and orthosis for treating rheumatoid arthritis.  Cochrane Database of Systematic Reviews. 2003;  CD004018
    Search in Google Scholar
  • 49 Veehof M M, Taal E, Heijnsdijk-Rouwenhorst L M et al. Efficacy of wrist working splints in patients with rheumatoid arthritis: a randomized controlled study.  Arthritis & Rheumatism. 2008;  59 1698-1704
    Search in Google Scholar
  • 50 Silva A C, Jones A, Silva P G et al. Effectiveness of a night-time hand positioning splint in rheumatoid arthritis: a randomized controlled trial.  J Rehabil Med. 2008;  40 749-754
    Search in Google Scholar
  • 51 Adams J, Burridge J, Mullee M et al. The clinical effectiveness of static resting splints in early rheumatoid arthritis: a randomized controlled trial.  Rheumatology. 2008;  47 1548-1553
    Search in Google Scholar
  • 52 Wessel J. The effectiveness of hand exercises for persons with rheumatoid arthritis: a systematic review.  J Hand Ther. 2004;  17 174-180
    Search in Google Scholar
  • 53 Brorsson S, Hilliges M, Sollerman C et al. A six-week hand exercise programme improves strength and hand function in patients with rheumatoid arthritis.  J Rehabil Med. 2009;  41 338-342
    Search in Google Scholar
  • 54 Göksel K A, Günaydin R, Adibelli Z H et al. Foot deformities in patients with rheumatoid arthritis: the relationship with foor functions.  Int J Rheum Dis. 2010;  13 158-163
    Search in Google Scholar
  • 55 Hawke F, Bums J, Radford J A et al. Custom-made foot orthoses for the treatment of foot pain.  Cochrane Database of Systematic Reviews. 2008;  CD006801
    Search in Google Scholar
  • 56 Pelland L, Brosseau L, Casimiro L et al. Electrical stimulation for the treatment of rheumatoid arthritis.  Cochrane Database of Systematic Reviews. 2002;  CD003687
    Search in Google Scholar
  • 57 Casimiro L, Barnsley L, Brosseau L et al. Acupuncture and electroacupuncture for the treatment of rheumatoid arthritis.  Cochrane Database of Systematic Reviews. 2005;  CD003788
    Search in Google Scholar
  • 58 Casimiro L, Brosseau L, Welch V et al. Therapeutic ultrasound for the treatment of rheumatoid arthritis.  Cochrane Database of Systematic Reviews. 2002;  CD003787
    Search in Google Scholar
  • 59 Brosseau L, Welch V, Wells G A et al. Low level laser therapy (classes I, II, and II) for treating rheumatoid arthritis.  Cochrane Database of Systematic Reviews. 2005;  CD002049
    Search in Google Scholar
  • 60 Meireles S M, Jones A, Jemmings F et al. Assessment of the effectiveness of low-level laser therapy on the hands of patients with rheumatoid arthritis: a randomized double-blind controlled trial.  Clin Rheumatol. 2010;  29 501-509
    Search in Google Scholar
  • 61 Welch V, Brosseau L, Casimiro L et al. Thermotherapy for treating rheumatoid arthritis.  Cochrane Database of Systematic Reviews. 2002;  CD002826
    Search in Google Scholar
  • 62 Oosterveld F GJ, Rasker J J, Floors M et al. Infred sauna in patients with rheumatoid arthritis and ankylsing spondylitis.  Clin Rheumatol. 2009;  28 29-34
    Search in Google Scholar
  • 63 Lee M S, Shin B C, Ernst E. Acupuncture for rheumatoid arthritis: a systematic review.  Rheumatology. 2008;  47 1747-1753
    Search in Google Scholar
  • 64 Wang C, de Pablo P, Chien X et al. Acupuncture for pain relief in patients with rheumatoid arthritis: a systematic review.  Arthritis & Rheumatism. 2008;  59 1249-1256
    Search in Google Scholar
  • 65 Verhagen A P, Bierma-Zeinstra S MA, Cardoso J R et al. Balneotherapy for rheumatoid arthritis.  Cochrane Database of Systematic Reviews. 2004;  CD000518
    Search in Google Scholar
  • 66 Yurtkuran M, Yurtkuran M A, Dilek K et al. A randomized, controlled study of balneotherapy in patients with rheumatois arthritis.  Phys Rehab Kur Med. 1999;  9 92-96
    Search in Google Scholar
  • 67 Franke A, Reiner L, Resch K L. Long-term benefit of radon spa therapy in the rehabilitation of rheumatoid arthritis: a randomized, double-blinded trial.  Rheumatol Int. 2007;  27 703-713
    Search in Google Scholar
  • 68 Hagen K B, Byfuglien M G, Falzon L et al. Dietary interventions for rheumatoid arthritis.  Cochrane Database of Systematic Reviews. 2009;  CD006400
    Search in Google Scholar
  • 69 Smedslund G, Byfuglien M G, Olsen S U et al. Effectiveness and safetly of dietary interventions for rheumatoid arthritis: a systematic review of randomized controlled trials.  J Am Diet Assoc. 2010;  110 727-735
    Search in Google Scholar
  • 70 Little C V, Parsons T. Herbal therapy for treating rheumatoid arthritis.  Cochrane Database of Systematic Reviews. 2000;  CD002948
    Search in Google Scholar
  • 71 Goldbach-Mansky R, Wilson M, Fleischmann R et al. Comparison of Tripterygium wilfordii Hook F versus sulfasalazine in the treatment of rheumatoid arthritis: a randomized trial.  Ann Int Med. 2009;  151 229-240
    Search in Google Scholar
  • 72 Astin J A, Beckner W, Soeken K et al. Psychological interventions for rheumatoid arthritis: a meta-analysis of randomized controlled trials.  Arthritis & Rheumatism. 2002;  47 291-302
    Search in Google Scholar
  • 73 Riemsma R P, Kirwan J R, Taal E et al. Patient education for adults with rheumatoid arthritis.  Cochrane Database of Systematic Reviews. 2003;  CD003688
    Search in Google Scholar
  • 74 Edwards R R, Giles J, Birmingham III C O et al. Moderators of the negative effects of catastrophizing in arthritis.  Pain Medicine. 2010;  11 591-599
    Search in Google Scholar

Univ.-Prof. Dr. Katharina Kerschan-Schindl

Universitätsklinik für Physikalische Medizin und Rehabilitation, MUW, AKH Wien

Währinger Gürtel 18–20

1090 Wien, Österreich

Email: Katharina.Kerschan-Schindl@meduniwien.ac.at