Rehabilitation von Patienten mit rheumatoider Arthritis

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 independance as long as possible.

Kernaussagen

• Die rheumatoide Arthritis ist die häufigste entzündliche Gelenkerkrankung des Erwachsenenalters, Sie ist gekennzeichnet durch die Kardinalsymptome Schwellung und Schmerz und kann mit einer Bewegungseinschränkung einhergehen.

• Wesentlich ist die frühe Diagnostik und das Einleiten einer sachgemäßen Pharmakotherapie, welche das Fortschreiten der Erkrankung verhindert oder verzögert.

• Die Prävention (Sekundär- und Tertiärprävention) und Rehabilitation zielen auf die Erhaltung und Wiederherstellung eines optimalen funktionalen Gesundheitszustandes bei diesen Patienten ab.

• Das Assessment entsprechend den Core-Items des ICF ist dabei ein wichtiger Bestandteil des Rehabilitationprozesses und soll in regelmäßigen Abständen wiederholt werden.

• Unter den präventiven und rehabilitativen Interventionen für Patienten mit RA gibt es für die Trainingstherapie eindeutige Evidenz für deren Wirksamkeit. Durch regelmäßiges gezieltes Training lassen sich Ausdauer, Kraft und Funktion der Betroffenen verbessern ohne negative Effekte auf die Gelenke zu haben.

• Es besteht auch eindeutige Evidenz zugunsten der Wirksamkeit der Gelenkschutzinstruktion. Verschiedenen physikalisch-therapeutischen Maßnahmen wird ein zumindest kurzfristig positiver Effekt zugeschrieben, aussagekräftige Wirksamkeitsbelege bestehen jedoch kaum. Unklar ist auch ob die mediterrane Diät den Krankheitsprozess günstig zu beeinflussen vermag.

• Eine begleitende psycholgische Unterstützung zur Bewältigung von Schmerz und Stress wirkt sich kurzfristig positiv auf das Wohlbefinden der Patienten aus.

• Viele Interventionen, die im alltäglichen Management der RA-Patienten angewendet werden, sind trotz ihres mangelhaften Wirksamkeitsnachweis sinnvoll.

• Literatur

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