Medical rehabilitation of patients with rheumatoid arthritis according to disability and disease activity

Abstract

Rheumatoid arthritis (RA) is a chronic and progressive disease that mainly affects the connective tissue and joints. About 0.5 - 1.5% of the population are affected by RA. The disease is more common in women affecting all the body systems, particularly the joints [1,2]. The causes of the disease are unknown yet. Many factors can lead to the onset and development of this disease. Genetic factors, autoimmune causes, harmful habits and microbial infections can increase the incidence of RA [3]. The peak of RA incidence occurs in people aged between 30 - 45 years old, during the period of the highest professional activity. In developed countries, RA is associated with low productivity at work [4]. The severity of the inflammatory process in RA is more worsened by the fact that over 50% of patients cease their professional activities during the first 5 years of disease, whereas disability occurs in 10% of cases in the first 2 years from the disease onset [5]. Joint degeneration and the risk of subsequent functional impairment often affect the quality of life in patients with RA [6]. Although RA management has been greatly improved recently, the best therapeutic approach has not been identified yet. Several anti-rheumatic pharmacological agents are currently available, such as conventional synthetic and biological DMARDs [7]. Anti-inflammatory drug treatment suppresses the activity of the immune system and reduces the synthesis of inflammatory mediators, relieving the symptoms of the disease and slowing down joint impairment. However, the disease requires monitoring and treatment throughout the lifetime. Joint pain restricts functionality, daily activities, workload capacity and quality of life. The therapeutic approach of patients with RA involves both pharmacological and non-pharmacological treatment aimed at increasing functional independence. Functional rehabilitation treatment increases overall functional activity [8]. Despite many recent impressive breakthroughs in pharmacological and therapeutic approaches, patients with rheumatoid arthritis often require considerable functional rehabilitation. The need for physiological treatment is determined by the functional and structural deficiencies of the joint system, caused by a slow and progressive joint degeneration. Rehabilitation focuses on improving joint function and stability, increasing muscle strength and resistance, and reducing pain and inflammation. The main rehabilitation objectives for these patients are the maintenance and improvement of joint functionality and posture control, as well as overall joint mobility [9]. A combined approach of functional methods with pharmacological treatment is highly important. Patients with RA administer a great number of drugs for achieving and maintaining adequate control of the disease [10]. Therefore, further researches on the mechanisms of action of natural and artificial physical factors are required, which will increase the effectiveness of complex recovery treatment in patients with varying degrees of activity in rheumatoid arthritis. It is necessary to study the action of the rehabilitation programs in patients with RA in different periods of the disease activity within a randomized controlled study to assess the importance of implementing these programs into their rehabilitation process.[...]