People with rheumatoid arthritis are at risk of poor flexibility, muscle atrophy, decreased muscle strength and decreased cardiovascular endurance. Therefore, a multifactorial approach based on the use of drugs and rehabilitation methods is needed. Fortunately, with proper counseling, people with rheumatoid arthritis can exercise safely, improve their overall fitness, and lead an active life. Rehabilitation methods include appropriate periods of rest and activity modification; therapeutic methods, such as heating and cooling, or electrical stimulation; special bracing equipment. In this article, we will consider recovery methods and rehabilitation for rheumatoid arthritis.
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Rehabilitation for Rheumatoid Arthritis
Rest and energy conservation can be beneficial for sore joints, but should not be abused in the long run, as Potentially harmful side effects may occur. For example, a decrease in the range of motion, a breakdown, changes in the characteristics of articular loads and aerobic abilities decrease. Scientists examined patients on strict bed rest, and patients lost from 1.0% to 1.5% of their initial strength per day for two weeks.
A structured exercise program can be much more beneficial for the general well-being and functioning of a person with rheumatoid arthritis. Such a program should focus on stretching, strengthening and aerobic exercise while conserving energy.
Inflamed joints should be rested to prevent exacerbation of symptoms. For non-inflamed joints, the active stretching of all large joints is of great importance in preventing contracture and maintaining the current range in order to carry out most daily activities. It is generally believed that contractures can be prevented by daily exercise. Most importantly, for bedridden patients, the proper location is needed to prevent contractures. The treatment of contractures should be done in a safe manner, such that there is no overly aggressive stretching.
Rheumatoid arthritis rehabilitation and strengthening exercises should be used in non-inflamed joints. While isometric exercises (the length of your muscle does not change, the joints do not move), can help maintain strength, prevent injuries or alleviate fatigue. Daily isometric reductions of 10% -20% of maximum tension held for 10 seconds can support isometric forces. In patients with RA, it has been shown that isometric strengthening can lead to increased performance with reduced effort. Exercise programs should progress slowly.
Several studies have shown benefits from aerobic exercise or a water exercise program. It was also shown that a short-term intensive exercise program, consisting of dynamic and isometric strengthening and cycling, can improve muscle strength without harmful effects on the disease.
Water therapy may be helpful for people who have difficulty with weight or balance. We studied the aerobic performance of physically active women with early or long-term rheumatoid arthritis with healthy women. The physically active aerobic fitness of women was similar to healthy women. One group underwent a more rigorous curriculum, consisting of a training program, sports activities, and training on bicycles. The control group participated in physiotherapy but did not allow weight or high shock load. It was concluded that high-intensity exercises are more effective in improving functional abilities, aerobic fitness and muscle strength and, apparently, do not contribute to the deterioration of RA from the point of view of the x-ray picture.
External heat has a good effect on the skin and subcutaneous tissue. This is especially useful in cases where the goal is to heat joints that cover few soft tissues, such as in the arms and legs. External heat is delivered through three mechanisms: conductivity, convection, or conversion.
- Conducting methods: Hot wet compresses (with hydro-collators) that heat body tissues faster than dry heat, but no difference in therapeutic benefits has been reported. Paraffin wax heats the distal joints of the upper and lower extremities. An alternative is heating heaters. Contrast baths include alternating immersion of the limb in hot and cold water to create reflex hyperemia.
- Convective methods: Hydrotherapy involves the use of water, hot or cold, for the treatment of diseases. Forms of hydrotherapy include hydromassage baths (partial floating of the body), which are specifically used for RA, neurogenic pain, dislocations, and sprains, as well as diseases of the soft peripheral vessels.
- Conversion Methods: Thermal radiation, such as infrared radiation, is mainly used for patients who cannot tolerate the weight of hot compresses. Energy is absorbed by the skin and converted to surface heat.
Deep heating increases the temperature of the tissue at a deeper level without overheating the skin and subcutaneous fat. Examples of deep heating include ultrasound and diathermy (the use of high-frequency electromagnetic currents causes the heating of biological tissues), including short-wave and microwave.
- Ultrasound is used in a wide variety of conditions, including articular contracture, scar tissue, near joint inflammation, bursitis, muscle cramps and pain, and arthrosis. The form of ultrasound, phonophoresis, offers help in the transdermal movement of topical drugs. The most commonly used corticosteroids and local anesthetics. The main indications are the same as in the whole therapeutic use of ultrasound, as well as tendonitis, scar tissue, fasciitis, and adhesions.
- Diathermy, both short-wave and microwave, includes similar principles. A short wave uses lower frequencies than microwaves, and both use electromagnetic radiation to heat tissue. They are used to heat relatively superficial muscles and joints.
Rehabilitation for rheumatoid arthritis and cold treatment has several physiological effects that enhance or inhibit the normal response to certain irritants. Hemodynamic effects include the reflex narrowing of blood vessels followed by the relaxation of smooth muscles in the walls of blood vessels. Neuromuscular effects include slowing the speed of nerve conduction and decreasing the firing of the muscle spindle, which has been shown to reduce muscle stiffness. Effects in the joints occur due to a decrease in the activity of synovial collagenosis, which makes it effective in inflammatory arthropathies. Common uses include cold relief of muscle spasm, as well as controlling inflammation in the acute stage of inflammation.
Electrotherapy involves the use of electrical impulses to stimulate muscles or nerves. The main indication for the use of electrotherapy is analgesia.
- Electrical nerve stimulation: The main delivery mechanism is via electrical cutaneous nerve stimulation. Its use is positive in RA and OA and among other conditions. Common applications include musculoskeletal pain, peripheral nerve injuries, peripheral neuropathy, postoperative pain, complex regional pain syndrome.
- Iontophoresis: works through the skin delivery of charged drugs (e.g., corticosteroid drugs, salicylates, antibiotics). Its effectiveness has not been proven but is used to deliver substances that need local penetration to avoid systemic effects, and in cases where oral absorption is variable or contraindicated.
- Interference current: uses AC signals of various frequencies to penetrate tissue without discomfort. Proposed applications include locomotor or neurological conditions, although, like most of the other methods mentioned, the literature does not demonstrate certain advantages over placebo.
Rehabilitation for rheumatoid arthritis using orthopedic devices.
Deformations due to RA or OA can limit the patient’s functioning, often the neglected consequence of the disease. Most deformities are associated with arms, knees, legs, and shoulders. A carefully considered decision must be made regarding the purpose of orthopedic use (for example, prevention of flat feet, getting rid of joint contracture). Joint preservation methods are vital to extend patient autonomy. Orthopedic devices can greatly facilitate everyday life, which will lead to greater independence. A physiotherapist can also help teach patients which movements to avoid.
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