Article

Complex rehabilitation and the clinical condition of working rheumatoid arthritis patients: does cryotherapy always overtop traditional rehabilitation?

Authors:
  • poland coms
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Abstract

Aim: Rehabilitation slows the progress of rheumatoid arthritis (RA) and prevents progression of disability. This study aimed to compare the impact of two rehabilitation programmes on pain, disease activity, locomotor function, global health and work ability forecast in RA patients. Materials and methods: Sixty-four employed women aged 24-65 years participated in the study. All patients underwent individual and instrumental kinesiotherapy. Thirty-two patients underwent cryogenic chamber therapy and local cryotherapy as well as non-weight-bearing, instrumental and individual kinesiotherapy. The remaining 32 patients received traditional rehabilitation in the form of electromagnetic and instrumental therapy, individual and pool-based non-weight-bearing kinesiotherapy. Rehabilitation lasted 3 weeks. Patients were examined three times: prior to rehabilitation, after 3 weeks of therapy and 3 months after completion of rehabilitation. The following study instruments were used: to assess disease activity: DAS-28; functional impairment: HAQ-DI; pain severity: VAS; patients' overall well-being: a scale from 0 to 100 (Global Health Index); and patients' own prognosis of fitness for work: the 6th question from Work Ability Index (WAI). Statistical analysis of data was performed using the STATISTICA 8.0 package. Mixed-design two-way analysis of variance was used for hypothesis testing. Results: All patients improved after rehabilitation. The group of patients those who underwent cryotherapy had improved DAS-28, HAQ-DI, VAS and global health scores immediately following the 3-week rehabilitation programme (p < 0.001, p = 0.001, p = 0.007 and p < 0.001, respectively), as well as at the 3-month follow-up (p < 0.001, p < 0.001, p = 0.009 and p < 0.001, respectively). Rehabilitation using cryotherapy resulted in greater improvement in disease activity DAS-28 [F(2,105) = 5.700; p = 0.007; η(2) = 0.084] and HAQ-DI locomotor function scores [F(2,109) = 6.771; p = 0.003; η(2) = 0.098] compared to traditional rehabilitation. The impact of both forms of rehabilitation on patients' own prognosis of work ability in the next 2 years was not significant. Results of patients who underwent traditional approach showed decreased disease activity following the initial 3-week period; however, this improvement did not sustain to the end of follow-up, 3 months later. Conclusions: Complex rehabilitation in RA has a positive effect on patients' clinical condition. The rehabilitation programme that includes cryotherapy overtops traditional rehabilitation, particularly as regards improvement in locomotor function, disease activity and sustaining willingness to continue working and exerts long-lasting effect. Implications for Rehabilitation Rehabilitation using cryotherapy is more effective in improving locomotor function, decreasing disease activity and sustaining willingness to continue working compared to traditional rehabilitation. Rehabilitation using cryotherapy significantly reduces the intensity of pain experienced by patients with RA, and this positive effect is maintained at 3 months post-rehabilitation. Complex rehabilitation, particularly treatment using cryotherapy, improves patients' subjective assessment of their overall well-being and perception of their disease. Complex rehabilitation in rheumatoid arthritis has a positive effect on patients' clinical condition.

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... WBC was developed in Japan in the late 1970s and has been used in Europe since the mid-1980s (8). Nowadays, it is often used in rehabilitation (9), but many commercial providers (10) also offer WBC treatment sessions that can be purchased and used individually. Beneficial effects of WBC are advertised by these commercial providers. ...
... Although the advertised effects in healthy individuals for regenerative purposes might hold promise, the clinical evidence regarding real effects in RA patients is scarce. Thus far, WBC has been compared to different application forms of local cryotherapy (8,11), it has been evaluated at different freezing temperatures (8,11), and it has been compared to different physical therapy (PT) and rehabilitation programmes and modalities in RA patients (9,12,13). However, no randomised controlled trial to date has evaluated the effects of WBC compared with placebo or no treatment in RA patients. ...
... The results showing beneficial effects of WBC in this study are consistent with previous work (8,9,(11)(12)(13), albeit study design and hypothesis are not comparable. To the best of our knowledge, WBC was clinically evaluated in 5 studies thus far (8,9,(11)(12)(13). ...
Article
Objectives: To evaluate effects of whole-body cryotherapy (WBC) in rheumatoid arthritis (RA). Methods: Patients with active RA undergoing a 16-day multimodal rheumatologic complex treatment were randomly assigned to either WBC (6 applications in 14 days at -130°C for 3 min) or no treatment. The primary outcome was the difference between groups in pain on a numerical rating scale after intervention. Secondary outcomes assessed effects on i) disease activity, ii) functional capacity, iii) cytokine levels, and iv) use of analgesics. Results: A total of 56 RA patients completed the trial (intervention group [IG]: 31 patients, control group [CG]: 25 patients). The mean change (± standard error) in pain after intervention was -2 in the IG (95% confidence interval [CI] -2.75 to -1.31, p<0.001) and -0.88 (95% CI -1.43 to -0.33, p=0.003) in the CG, with a baseline-adjusted between-group difference of -1.31 ± 0.4 (95% CI -2.1 to -0.53; p=0.002). Pain at the 12-week follow-up visit remained significantly below baseline values in the IG. Disease activity and functional capacity showed statistically and clinically meaningful improvement after intervention but were not significant at the 12-week follow up. TNF and IL-6 levels changed significantly in the IG. Eighteen of 31 (58%) patients of the IG reduced or discontinued analgesics at the 12-week follow-up. No WBC-related side effects were reported. Conclusions: WBC in RA reduces pain and disease activity significantly and in a clinically meaningful manner, resulting in a reduction of analgesics. These effects are potentially based on a change in cytokine levels.
... Rehabilitation using cryotherapy is more effective in improving motor function compared to traditional rehabilitation. Rehabilitation using cryotherapy signifi cantly reduces the intensity of pain experienced by patients with RA, and the positive effect lasts for 3 months after rehabilitation 45 . ...
... Księżopolska et al. 45 compared the effects of two rehabilitation programmes for patients with RA. The physiotherapy programme lasted three weeks. ...
Article
Full-text available
Study aim: The aim of this study was to assess the effects of systemic cryotherapy on the rheological properties of the blood in women with rheumatoid arthritis. Study group: The study group consisted of 10 women with rheumatoid arthritis, aged 57.2 ± 9.4, who underwent systemic cryotherapy treatments (3 min treatment time, -120 °C chamber temperature, 10 treatment sessions - 5 times a week). Their average body height was 165.5 ± 4.6 cm, weight 68.5 ± 4.9 kg and BMI 24.8 ± 2.2 kg/m2. In order to analyze morphological and rheological parameters of the blood, venous blood samples were drawn from the participants of the study twice. The first study was held on the day of beginning treatments and the second test was conducted after a series of 10 treatments. Methodology: The morphological blood test - measurements were taken using the ABX MICROS 60 (USA) hematology analyser. Erythrocyte deformability and aggregation were tested using the LORCA analyser (Laser-assisted Optical Rotational Cell Analyser RR Mechatronics, The Netherlands). The results were obtained as the index of elongation and aggregation according to the Hardeman method (2001). Results: Analysing the average values of morphological and rheological parameters of the blood in women with rheumatoid arthritis in the study group, the mean values of RBC, Hct and AI following the series of 10 treatments were significantly higher after cryotherapy in comparison to the measurements taken before treatments. Analysing the mean concentrations of T½, there was statistically significant reduction after the series of 10 treatments. Conclusions: Regular usage of cryotherapy treatments may affect the levels of morphological and rheological parameters of the blood in women with rheumatoid arthritis - RBC, Hct and AI (increase) and T½ (reduction) in the blood. null
... Il est naturel que les kinésithérapeutes s'y intéressent. Les chambres cryogéniques en corps entier [5] ont montré leur intérêt sur la douleur [7,8], l'inflammation [9][10][11], la mobilité articulaire [12,13], la récupération musculaire [14,15] et la complémentarité avec la kinésithérapie [13,16]. La durée des protocoles utilisés varie de 120 s à 240 s en fonction des études [10,[17][18][19]. ...
... Il est naturel que les kinésithérapeutes s'y intéressent. Les chambres cryogéniques en corps entier [5] ont montré leur intérêt sur la douleur [7,8], l'inflammation [9][10][11], la mobilité articulaire [12,13], la récupération musculaire [14,15] et la complémentarité avec la kinésithérapie [13,16]. La durée des protocoles utilisés varie de 120 s à 240 s en fonction des études [10,[17][18][19]. ...
Article
Cet article pose les bases d’une modélisation théorique visant à déterminer une loi d’évolution de la température cutanée d’un sujet, au cours d’une séance de cryothérapie en corps entier (CCE). L’étude se focalise sur les quelques minutes pendant lesquelles le corps humain est soumis à un choc thermique. À notre connaissance, aucune donnée n’est documentée dans la littérature sur la température de la peau pendant la phase de refroidissement. La validation de cette démarche scientifique ouvre une voie large à des études de plus grande ampleur dans le but de proposer des protocoles de cryothérapie pouvant être à la fois individualisés mais également destinés à des populations cibles.
... Помимо теплолечения эффективность криотерапии как метода снижения болевого синдрома и активности заболевания показаны в ряде исследований [53][54][55]. Эффект воздействия различных температур связан со снижением активности окислительных процессов внутри сустава, что замедляет аутоиммунный процесс [56]. Применение магнитотерапии -это также один из основных методов лечения пациентов после эндопротезирования. ...
Article
Rheumatoid arthritis is a social problem due to high disability, reaching 90% among the population. A detailed disclosure of the social significance of nosology shows that in the first 5 years of the disease, about half of the patients get a disability, in the first 10 years 2/3 of the patients. The destruction of large joints is the result of a long course of the disease. Many studies say that after 10 years from the onset of the disease, a third of patients need arthroplasty of the large joints of the lower extremities. Polyarthritic joint damage leads to the difficulty of carrying out restorative treatment. The article the main methods of rehabilitation of patients after arthroplasty of the joints of the lower extremities, assessed the effectiveness of each method in the treatment of patients with osteoarthritis of large joints, and proposed their own version of therapeutic physical activity in water. The advantage of this method is to reduce pressure on other joints and to concentrate force on the operated limb. In addition, some authors talk about the analgesic effect of thermotherapy, ultrasound therapy and balneotherapy. Thus, the postoperative treatment of patients with rheumatoid arthritis is an important part of the overall treatment and enhances the effectiveness of surgical correction. The most important and accessible physiotherapy procedures are kinesiotherapy and aqua gymnastics. According to the results of the article, other methods only complement the main therapeutic effect.
... Cryostimulation relies on the use of temperatures below -100°C for about 3 minutes to produce a thermal effect, which reduces pain and increase the range of motion [15]. This method is more effective than other methods of conventional physiotherapy; it reduces pain, improves locomotion and maintains the desire to continue professional work in patients with RA [16]. ...
Article
Full-text available
Objectives: Whole body cryotherapy (WBC) is widely used in inflammatory diseases of the joints, including rheumatoid arthritis (RA), but the mechanism(s) of its action is not fully understood. The aim of the study was to compare the effects of WBC and conventional rehabilitation (CR) on the clinical and immune status of RA patients. Material and methods: Rheumatoid arthritis patients were classified into 2 groups according to the rehabilitation method used: the study group (CT, n = 25) and control group (CR, n = 25). To measure disease activity, the disease activity score (DAS28) was used, while to assess the morning stiffness and pain intensity, the visual analogue scale (VAS) was applied. Selected laboratory parameters, such as erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels, were also determined. The serum concentrations of pro- (interleukin 6 [IL-6], tumor necrosis factor α [TNF-α], macrophage migration inhibitory factor [MIF]) and anti-inflammatory (IL-10) cytokines were measured to assess the patient's immune status. Results: After rehabilitation disease activity (DAS28), morning stiffness and pain intensity (VAS) decreased in both patient groups and no statistically significant differences were observed between them. However, statistically significant improvement in the CRP serum level was observed in the CT group only. No differences were observed in the serum concentrations of tested cytokines either before and after rehabilitation, or between patient groups. Conclusions: We report that regardless of the type of therapy, comprehensive rehabilitation improves the patient's clinical status, but has no effect on the levels of circulating cytokines, such as IL-6, IL-10, TNF-α, and MIF, despite significant reduction of a systemic inflammatory marker (CRP), especially in the CT group.
... Cryotherapy in cryosaunas or cryochambers is the therapeutic application of extremely cold dry air, usually between −140°C and −110°C with proven virtues on a number of pathologies such as pain [1] and inflammation stemming from sports injuries and muscular recovery [2][3][4][5][6][7], fibromyalgia [8,9], rheumatoid arthritis [10], multiple sclerosis [11], sleep [12] and depressive disorders [13], or skin diseases like psoriasis and dermatitis [14]. ...
Article
Because of the scarcity of the literature on the comparative efficiency of Partial Body Cryotherapy versus Whole Body Cryotherapy, it appears that the decision to switch from the former to the latter is purely arbitrary and does not actually meet any scientifically established criterion. The motivation of this study is to draw up an objective observation of the differences between Partial Body Cryotherapy and Whole Body Cryotherapy treatments, based on the analysis of skin temperature distribution. Ten healthy subjects who engage in regular physical activity participated in the study (50% female; means ± S.D.: age 45.8 ± 5.5 years, height 168.7 ± 9,3 cm, weight 75.3 ± 13.1 kg, body fat percentage 19.3 ± 9,8). Sessions took place in a cryosauna and a cryochamber at identical temperature (−140 °C), duration of cryostimulation (3 min) and nature of the refrigerant used (liquid nitrogen vapor). It is shown that the skin temperature difference between Partial Body Cryotherapy and Whole Body Cryotherapy varies according to the vertical location of the body regions, increasingly from 15% on the lower areas of the body (no significant difference in skin temperature for legs P =.171) up to 53% for the upper areas (significant difference P < 0.001 for chest). These observations show the caution with which these two cryotherapy systems must be considered. The knowledge of the differences in cutaneous thermal response between these two systems should guide sports coaches and physicians in prescribing differentiated treatment protocols in order to achieve comparable skin temperature effects and consequently to efficiently cool tissues in the same way.
... In addition, several authors mention an increase in cortisol levels linked to activation of the sympathetic nervous system by activation of the autonomic nervous system, a corticosteroid hormone and neuroendocrine stress marker in modulating pain and mood. [19][20][21] ...
... In addition, several authors mention an increase in cortisol levels linked to activation of the sympathetic nervous system by activation of the autonomic nervous system, a corticosteroid hormone and neuroendocrine stress marker in modulating pain and mood. [19][20][21] ...
... Because of active disease, we considered unethical to extend the time period of cold treatment while keeping the drug therapy unchanged for more than 7 days. Recently, rehabilitation using cold treatments including cold chamber therapy and local cryotherapy during a rehabilitation period of 3 weeks was reported to result in greater improvement in disease activity and function in RA patients compared with the traditional rehabilitation [30]. ...
Article
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Patients with rheumatoid arthritis (RA) have increased oxidative stress, decreased antioxidant levels, and impaired antioxidant capacity. Cold treatments are used to relieve joint inflammation and pain. Therefore, we measured the effect of cold treatments on the antioxidative capacity of RA patients with active disease. Sixty patients were randomized to (1) whole body cryotherapy at -110 °C, (2) whole body cryotherapy at -60 °C, or (3) local cryotherapy. Each treatment was given three times daily for 7 consecutive days in addition to the conventional rehabilitation. Blinded rheumatologist evaluated disease activity before the first and after the last cryotherapy. We collected plasma samples daily immediately before the first and after the second cryotherapy and measured total peroxyl radical trapping antioxidant capacity of plasma (TRAP), which reflects global combined antioxidant capacity of all individual antioxidants in plasma. Baseline morning TRAP levels (mean, 95% CI), adjusted for age, body mass index, disease activity, and dose of prednisolone, were 1244 (1098-1391) µM/l in the local cryotherapy, 1133 (1022-1245) µM/l in the cryotherapy at -60 °C, and 989 (895-1082) µM/l in the cryotherapy at -110 °C groups (p = 0.006). After the first treatment, there was a rise in 1-h TRAP of 14.2 (-4.2 to 32.6) µM/l, 16.1 (-7.4 to 39.6) µM/l, and 23.6 (4.1-43.2) µM/l, respectively. The increase was significant in the whole-body cryotherapy -110 °C group (p < 0.001) but not significant between the groups (p = 0.78). When analyzed for the whole week, the daily morning TRAP values differed significantly between the treatment groups (p = 0.021), but there was no significant change within each treatment group. Whole-body cryotherapy at -110 °C induced a short-term increase in TRAP during the first treatment session with but not during other treatment modalities. The effect was short and the cold treatments did not cause a significant oxidative stress or adaptation during 1 week.
Article
The goals in the management of established rheumatoid arthritis (RA) are to control pain and disease activity, prevent further joint damage, and enhance functioning and quality of life. Despite the fact that aggressive and the early use of biological and nonbiological disease-modifying antirheumatic drugs have been associated with substantial gains in clinical, radiological, and disability outcomes, a considerable proportion of patients still report significant problems of physical, emotional and social functioning, and unmet needs in established RA. Therefore, nonpharmacological treatments are also administered for patients with RA. The aim of this article is to overview the nonpharmacological, therapeutical, and rehabilitative interventions, to minimize the consequences of the disease in patients with established RA. First, the principles of functional assessment in RA will be addressed. Then nonpharmacological interventions including therapeutic patient education, exercise therapy, physical modalities, orthoses, assistive devices, dietary interventions, and balneotherapy will be reviewed in the light of evidence-based literature data.
Chapter
Whole Body Cryotherapy (WBC) can be considered a therapeutic complement consisting in placing the human body in a hermetic chamber within which temperature varies between \(-110\,^{\circ }\)C and \(-60\,^{\circ }\)C over a short period of time. Despite the benefits of cryotherapy, subject safety must be ensured during the exposure to extreme cold, in the sense that the physiology of the human body should not be altered. Thus during a WBC session, accurate knowledge regarding the thermal transfer occurring at the cutaneous surface of the patient is essential. To this end, aeraulic and thermal conditions within the cryotherapy cabin are fundamental. The experimental study presented in this paper is based on the acquisition of skin temperature mappings. The derived boundary conditions are applied to the associated numerical problem which is solved using Computational Fluid Dynamics (CFD).
Chapter
Physical modalities are tools that can be used to complement a patient's rehabilitation treatment plan through the use of thermal, sound, electrical, and light energy. They can be used to address pain, swelling, soft tissue restrictions, joint range of motion (ROM) limitations, and muscle weakness, as well as to promote tissue healing, thereby improving a patient's ability to participate in other aspects of rehabilitation therapy (e.g., therapeutic exercise, functional mobility retraining, etc.). A general overview of the physical modalities most commonly used in canine rehabilitation is presented, with a goal of assisting the therapist in determining if and when their use may improve treatment outcome. The modalities discussed are cryotherapy and superficial heating (superficial thermal agents), therapeutic ultrasound (TUS), neuromuscular electrical stimulation (NMES) and transcutaneous electrical nerve stimulation (TENS) (electrical stimulation modalities), low-level laser therapy (LLLT)/photobiomodulation, and extracorporeal shock wave therapy (ESWT). Patients affected by orthopedic and neurological injuries, working and sporting dogs, and the geriatric population can all benefit from use of physical modalities at some point during their rehabilitation program.
Article
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Introduction: Rheumatoid arthritis (RA) is an autoimmune, chronic and inflammatory disease, which the affected patients present a higher cardiovascular mortality rate. Physical activities have been identified as the most important strategy to prevent cardiovascular diseases. However, the articular damage and the chronic pain caused by RA challenges its regular practice. Moreover, persons with RA tend to avoid PA due to the fear of exacerbating the inflammatory potential and pain. One alternative to avoid the collateral effects of the PA could be the cryotherapy. Therefore, this study aimed to review studies focused on the use of both PA and cryotherapy in RA patients and to identify evidences that both therapies could be combined in order to optimize the symptomatic treatment. Evidence acquisition: Four databases (MEDLINE, CINAHL, Elsevier and PEDro) were searched to identify publications regarding RA patients, PA and cryotherapy intervention by the terms and operators (rheumatoid arthritis AND exercise OR physical activity OR activity OR training OR reconditioning OR cryotherapy OR cold OR immersion). The selected studies should at least present one measure of the aerobic capacity, disease activity or pain relief. Among 19 studies with RA patients identified, only 4 studies used PA combined with cryotherapy. The other 13 studies used physical activities and 2 studies used cryotherapy intervention. Evidence synthesis: The results of the physical activities combined with cryotherapy studies showed an improvement in the disease activity and pain relief, however without details of the physical activities intervention and an aerobic capacity. Among the physical activities studies, evidence was found suggesting that aerobic exercises and multiactivity exercises with high intensity are the more effective for improve the aerobic capacity. Conclusions: Even if few studies on cryotherapy were found, there are enough evidences in the literature that demonstrate the benefits of this intervention on pain relief and disease activity. In summary, neither study found associated physical activities to improve aerobic capacity with cryotherapy to improve disease activity and pain relief. This may be an innovative therapeutic strategy to improve the aerobic capacity in arthritis patients and consequently reduce their cardiovascular risk while minimizing pain and disease activity.
Article
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The aim of this article was to review current evidence about cryotherapy in inflammatory rheumatic diseases (therapeutic and biological effects). For therapeutic effects, we performed a systematic review (PubMed, EMBASE, Cochrane Library, LILACS databases, unpublished data) and selected studies including non-operated and non-infected arthritic patients treated with local cryotherapy or whole-body cryotherapy. By pooling 6 studies including 257 rheumatoid arthritis (RA) patients, we showed a significant decrease in pain visual analogic scale (mm) and 28-joint disease activity score after chronic cryotherapy in RA patients. For molecular pathways, local cryotherapy induces an intrajoint temperature decrease, which might downregulate several mediators involved in joint inflammation and destruction (cytokines, cartilage-degrading enzymes, proangiogenic factors), but studies in RA are rare. Cryotherapy should be included in RA therapeutic strategies as an adjunct therapy, with potential corticosteroid and nonsteroidal anti-inflammatory drug dose-sparing effects. However, techniques and protocols should be more precisely defined in randomized controlled trials with stronger methodology.
Article
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Article
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The musculoskeletal diseases requiring rehabilitation can be classified into two groups. One group is connected with the aging of bones (osteoporosis) and joints (osteoarthritis). The second group covers the rheumatoid diseases connected with the immunology system. The aim of rehabilitation is to prevent deformations and to treat existing deformations. The condition to achieve improvement is to apply simultaneously the following: analgesic procedures, adjusting the muscle tension and relieving through applying kinesiotherapy, physiotherapy and orthopaedic aids. Occupational and social rehabilitation is also very important. The results achieved from the complex rehabilitation are used, above all, to estimate the improvement of functional abilities among the patients. The questionnaires for each disease are used for it, e.g. HAQ for RA, tiredness index or SF-36, and the greatest hopes are invested in the International Classification of Functioning, Disability and Health (ICF). The rehabilitation of patients suffering from rheumatic diseases is one of the parts of the complex treatment to be carried out until the end of life. This is immensely vital in the first disease stage when there are no fixed changes. It requires a lot of modifications under the rehabilitation specialist's supervision and pharmacological treatment administrated by the rheumatologist.
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The objective of the present study was to develop the program for combined step-by-step rehabilitation of the patients presenting with early-onset rheumatoid arthritis (RA); the secondary objective was to estimate the effectiveness of this program. A total of 34 patients were recruited for the participation in the study. They received medicamental therapy in combination with the rehabilitative treatment during 6 months. The hospital-based treatment included therapeutic exercises for large joints under the supervision of a specialist (45 min), occupational therapy (45 min), local aerial cryotherapy of wrist, knee, and ankle joints (10 sessions 15 min each at a temperature of -60 degrees C), ortheses, and the educational program (4 daily studies 90 min each). The outpatient and home-based treatment included therapeutic exercises for large joints (45 min), wrist exercises (45 min) three times every week, ortheses. 26 patients received only medicamental therapy (control group). The following characteristics were measured: the average power of extension of knee joints and of flexion of ankle joints (by means of En-TreeM analysis of movements), wrist grip strength, articular pain (100 mm VAS, DAS28, HAQ, RAPID3 indices). The rehabilitative program ensured excellent compliance with basal therapy, reduced requirements for symptomatic medicines, and improved adherence to the methods for the formation of the correct movement patterns, orthesis wearing, and regular therapeutic exercises. The rehabilitative treatment resulted in the relief of articular pain by 70.4% (p < 0.01), decrease of DAS28 by 31.9% (p < 0.05), HAQ by 75.8% (p < 0.01), and RAPID3 by 60.1% (p < 0.01). The grip strength of the more seriously injured wrist increased by 44.9% (p < 0.05) and that of the less damaged one by 31.3% (p < 0.05). The average extension power of the weaker knee joint increased by 88.7% (p < 0.01) and that of the stronger joint by 67.7% (p < 0.01). The average flexion power of the more seriously injured ankle joint increased by 81.6% (p < 0.01) and that of the less damaged one by 70.2% (p < 0.01). The two groups were significantly different in terms of the majority of characteristics evaluated. It is concluded that the combined rehabilitative treatment helps to control the activity of the disease, enhances the functional abilities, improves the locomotor activity and quality of life of the patients with early-onset rheumatoid arthritis.
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The revised criteria for the classification of rheumatoid arthritis (RA) were formulated from a computerized analysis of 262 contemporary, consecutively studied patients with RA and 262 control subjects with rheumatic diseases other than RA (non-RA). The new criteria are as follows: 1) morning stiffness in and around joints lasting at least 1 hour before maximal improvement; 2) soft tissue swelling (arthritis) of 3 or more joint areas observed by a physician; 3) swelling (arthritis) of the proximal interphalangeal, metacarpophalangeal, or wrist joints; 4) symmetric swelling (arthritis); 5) rheumatoid nodules; 6) the presence of rheumatoid factor; and 7) radiographic erosions and/or periarticular osteopenia in hand and/or wrist joints. Criteria 1 through 4 must have been present for at least 6 weeks. Rheumatoid arthritis is defined by the presence of 4 or more criteria, and no further qualifications (classic, definite, or probable) or list of exclusions are required. In addition, a “classification tree” schema is presented which performs equally as well as the traditional (4 of 7) format. The new criteria demonstrated 91–94% sensitivity and 89% specificity for RA when compared with non-RA rheumatic disease control subjects.
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Hand pathology can cause functional disability and deterioration in the quality of life by altering the grip and therefore, it requires a complex approach by a multidisciplinary team, including physiotherapists and occupational therapists. Orthoses are an important part of the treatment of these pathologies. A thorough understanding of the pathogenesis of lesions and their risk of progression to deformities is required for an appropriate use. Their fabrication by a specialized therapist and also their monitoring assure a good compliance. Their effectiveness depends on the patient adherence, for which information and education are essential. The role of physiotherapist is to establish a personalised rehabilitation program, including passive and active exercises and also the prevention of joint stiffness. The main goal after surgery is to initiate an early active motion in order to decrease the risk of adhesions without compromising the suture by the use of a splint. The role of occupational therapist is important all along the treatment period, from the early rehabilitation to the moment of return to home environment. The literature search shows that there is a lack of good methodological clinical studies in order to assess the effectiveness and the costs of this medical treatment.
Article
Purpose: Drawing on data from a larger study, the aim of this paper is to illuminate how the everyday doings of women with disabilities are coordinated to and shaped by organizational processes and social context, particularly as these relate to the potential of being labelled disabled. Methods: An institutional ethnography was conducted with seven Austrian women diagnosed with rheumatoid arthritis (RA). Interviews and participant observations were conducted, and texts about the historical development of disability policies were identified. Data analysis included grouping similar doings of participants together to subsequently explore links between what the women did and how their doings are shaped by disability policies and the social context. Results: The women, who participated in this study, spent time and effort to keep the disease invisible, resist disability and negotiate a disability pass. By drawing upon the historical development of Austrian disability policies, the interpretation reveals how this development infiltrates into participants' lives and shapes their everyday doing. Conclusion: This study furthers understanding of how broader policies and practices, shaped over historical time, infiltrate into the daily lives of women with disabilities. It illustrates how full participation may not necessarily be a lived reality for people with disabilities at this point in Austria. Implications for Rehabilitation Maximising full participation for people with rheumatoid arthritis is important. This requires focusing not only on the bodily health of people with rheumatoid arthritis but also on their interaction with the social, cultural and political context in their daily lives. This requires also understanding how knowledge about disability is passed on from previous generations.
Article
The aim of this study was to evaluate the impact of a whole-body cryotherapy (WBCT) on various parameters of the mental state of patients depending on their age, gender, and diagnosed illness. The study included 55 subjects - 43 women and 12 men aged from 20 to 70 years. Based on the diagnosed illness, the patients were divided into two diagnostic groups. The first group consisted of patients with spinal pain syndromes (n = 34). The second group comprised patients with peripheral joint disease (n = 21). All patients underwent 10 WBCT sessions. The subjects completed a survey at two time points: before the first WBCT treatment (T1) and after completing the tenth treatment (T2). The World Health Organization Quality of Life-Bref (WHOQOL-Bref) questionnaire and the Psychological General Well-Being Index (PGWBI) questionnaire were used in the study. After a series of WBCT treatments, the WHOQOL-Bref and PGWBI scores significantly improved (p = .005161, p = .000862, respectively). WBCT proved to be more effective in enhancing the mood and well-being of the patients than in improving their quality of life. WBCT has a significant influence on improving the well-being and mood of patients (in terms of both psychological and somatic aspects) and consequently leads to an improvement in their quality of life. The worse the mental state of the patients is prior to the cryotherapy, the stronger its effect. The observed effectiveness of cryotherapy was the strongest in women, patients with spinal pains and in patients with severe depressive symptoms.
Article
Cryotherapies are frequently used to supplement the rehabilitation of patients with rheumatoid arthritis (RA) owing to their analgesic and anti-inflammatory effects. Forty patients with active RA were recruited and received 10 days of comprehensive therapy with different local cryotherapies. None of the respondents were subjected to biological treatment. They were divided into two groups according to the therapy received: nitrogen vapour at -160 °C (group I) or cold airflow at -30 °C (group II). Levels of tumour necrosis factor α (TNF-α), interleukin 6 (IL-6), disease activity score (DAS28), and functional variables were used to assess the outcomes. After the therapy, both groups exhibited similar improvements. Significant reduction in TNF-α level (nitrogen: p < 0.01; cold air: p < 0.05) and no change in IL-6 were observed. DAS28, the clinical severity of pain, duration of morning stiffness, degree of self-reported fatigue, and health assessment questionnaire (HAQ) scores improved significantly. In addition, the active range of knee extension, time, and the number of steps in the 50-m walk test also clearly got better in both groups. The 10-day comprehensive therapies including different local cryotherapies for the patients with RA cause significant decrease in TNF-α systemic levels, meaningly improve DAS28, HAQ scores, and some functional parameters, but do not change IL-6 levels. However, there were no differences in the effectiveness of either cryotherapy.
Article
Purpose: The purpose of the study was to examine muscle strength and pain sensitivity in postmenopausal women with and without RA. Methods: Ten women with and ten without early RA were recruited. All were postmenopausal, and did not use hormone replacement therapy. Measurements of isokinetic muscle strength in knee flexors/extensors, hand grip strength, timed standing, pressure pain thresholds (PPT), suprathreshold pressure pain, and segmental and plurisegmental endogenous pain inhibitory mechanisms during muscle contraction were assessed. Results: Participants with early RA were weaker in knee flexors, in hand grip strength and they needed more time for the timed standing. Women with early RA had higher sensitivity to threshold pain and suprathreshold pressure pain compared to women without RA. PPTs increased in the contracting muscle as well as in a distant resting muscle during static contractions in both groups. Conclusions: Our results indicate differences in muscular strength between postmenopausal women with and without RA. Furthermore, women with RA had decreased PPT and hyperalgesia, but no dysfunction of segmental or plurisegmental pain inhibitory mechanisms during static exercise compared to healthy controls. The normal function of endogenous pain inhibitory mechanisms despite chronic pain in women with RA might contribute to the good effects of physical activity previously reported.
Article
The aim of this study was to describe experiences of pain and its relationship to daily activities in people with rheumatoid arthritis (RA). Seven semi-structured focus group discussions were conducted with 33 men and women of different ages with RA. Data were analysed with content analysis. Pain affected everyday life and may be a barrier to perform valued activities. Regarding the impact of pain on participation and independence, personal factors and the social environment were found to be important. It could be a struggle to find the right activity balance, since it was easy to be overactive, triggering subsequent elevation of pain levels. However, the participants also described activities as a mediator of pain and a distraction from it. The relationship between pain and daily activities in RA was complex. Pain as an impairment was expressed to be related to activity limitations and participation restrictions, as well as to contextual factors. These findings highlight the clinical importance of paying attention to the complexity of pain and its relation to daily activities and participation.
Article
Conventional physiotherapy (electrotherapy, magnetic fields), kinesitherapy, and whole-body cryotherapy (plus kinesitherapy) are used to relieve pain and inflammation or to improve function in rheumatic diseases. The aim of this study was to investigate the effects of different physiotherapies and cryotherapy on biochemical blood parameters of patients with rheumatoid arthritis (RA) and osteoarthritis (OA). Twenty patients with RA and 17 patients with OA received whole-body cryotherapy at -140 to -160 degrees C for 2 to 3 min, once daily for 4 weeks. The second group of patients (24 with RA and 28 with OA) received conventional physiotherapy for 4 weeks. We measured the parameters of neutrophil activation (respiratory burst, calprotectin) and markers of cartilage metabolism [N-acetyl-beta-D-hexosaminidase (NAHase), ectonucleotide pyrophosphohydrolase (NTPPHase)] twice: before and 3 months after cryotherapy or physiotherapy. We showed, for the first time, that cryotherapy significantly reduced (P < 0.001) histamine levels in the blood of patients with RA. The effect was long-lasting (for at least 3 months). The levels of blood histamine in patients with OA were not changed significantly. Cryotherapy also downregulated the respiratory burst of PMNs and NAHase activity and upregulated calprotectin levels and the activity of NTPPHase. However, these changes were not statistically significant. In contrast, there were no significant changes in histamine levels or the other biochemical parameters measured in groups of patients treated only with physiotherapy and kinesitherapy. It may be concluded that the beneficial clinical effects of cryotherapy in RA patients are in part due to the action on the production, release, or degradation of histamine.
Article
As yet, whole-body cryotherapy is especially used for the therapy of chronic inflammatory arthritis. An analgetic effect has been described in several studies. However, only few data exist concerning the long-term effects of this therapy. A total of 60 patients with rheumatoid arthritis (n = 48), and ankylosing spondylitis (n = 12) was analyzed. Patients underwent treatment with whole-body cryotherapy twice a day. The average age was 55.7 +/- 10.33. The study group consisted of 48 female and twelve male patients. The average number of therapeutic treatments with cryotherapy was 15.8 +/- 8.37, the average follow-up 63.4 +/- 63.48 days. 13 patients (21.7%) discontinued treatment because of adverse effects. For patients with rheumatoid arthritis, DAS28 (Disease Activity Score) and VAS (visual analog scale) were determined. A significant reduction of both parameters was found (DAS 3.9 +/- 1.22 vs. 3.4 +/- 1.08; p < 0.01; VAS 51.4 +/- 16.62 vs. 37.9 +/- 19.13; p < 0.01). BASDAI (Bath Ankylosing Spondylitis Disease Activity Index) was analyzed for patients with ankylosing spondylitis, and also showed a significant reduction (4.4 +/- 1.91 vs. 3.1 +/- 1.34; p = 0.01). Thus, whole-body cryotherapy is an effective option in the concept of treatment of inflammatory rheumatic diseases. The relief of pain allows an intensification of physiotherapy. A significant reduction of pain over a period of 2 months could be shown.
Article
Over the last 2 decades, assessment of patient health status has undergone a dramatic paradigm shift, evolving from a predominant reliance on biochemical and physical measurements to an emphasis upon health outcomes based on the patient's personal appreciation of their illness. The Health Assessment Questionnaire (HAQ), published in 1980, was among the first instruments based on patient centered dimensions. The HAQ was designed to represent a model of patient oriented outcome assessment and has played a major role in diverse areas such as prediction of successful aging, inversion of the therapeutic pyramid in rheumatoid arthritis (RA), quantification of nonsteroidal antiinflammatory drug gastropathy, development of risk factor models for osteoarthrosis, and examination of mortality risks in RA. The HAQ has established itself as a valuable, effective, and sensitive tool for measurement of health status. It has increased the credibility and use of validated self-report measurement techniques as a quantifiable set of hard data endpoints and has contributed to a new appreciation of outcome assessment. We review the development, content, and dissemination of the HAQ and provide reference sources for its uses, translations, and validations. We discuss contemporary issues regarding outcome assessment instruments relative to the HAQ's identity and utility. These include: (1) the issue of labeling instruments as generic versus disease-specific; (2) floor and ceiling effects in scales such as "disability"; (3) distances between values on scales; and (4) the continuing introduction of new measurement instruments and their potential effects.
Article
Local cryotherapy is used to relieve pain and inflammation in injuries and inflammatory conditions. Whole-body cryotherapy is an extreme method administered at -110 degrees C for 2 to 3 minutes. The aim of the study was to compare the effect of cryotherapies on pain and inflammation in patients with rheumatoid arthritis (RA). Sixty patients with active seropositive RA were recruited in a randomised controlled single-blinded study to receive whole-body cryotherapy at -110 degrees C, whole-body cryotherapy at -60 degrees C, application of local cold air at -30 degrees C and the use of cold packs locally. In the final analysis, the last 2 groups were pooled. The patients had 2-3 cryotherapy sessions daily for one week plus conventional physiotherapy. Clinical and laboratory variables and patient's and physician's global assessments were used to assess the outcome. Disease activity was calculated by DAS. Pain decreased in all treatment groups, most markedly in the whole-body cryotherapy (-110 degrees C) group. DAS decreased slightly with no statistically significant differences between the groups. No serious or permanent adverse effects were detected. Six of 40 patients (15%) discontinued the whole-body cryotherapy. Pain seemed to decrease more in patients in the whole-body cryotherapy at -110 degrees C than during other cryotherapies, but there were no significant differences in the disease activity between the groups. However, cryotherapy at -110 degrees C is expensive and available only in special centres and may have minor adverse effects. Based on our results, whole-body cryotherapy at -110 degrees C is not superior to local cryotherapy commonly used in RA patients for pain relief and as an adjunct to physiotherapy.
Article
Medical rehabilitation after lower extremity arthroplasty is an integral part of recovery and a critical step in returning to independent mobility. We hypothesized that rehabilitation may take longer for patients with rheumatoid arthritis (RA) versus osteoarthritis (OA) because joint pain, swelling, and deformities are generally worse among persons with RA. To determine the impact of RA on length of rehabilitation stay and rehabilitation functional status gain after arthroplasty. We conducted a retrospective cohort analysis using a national registry of US medical rehabilitation inpatients admitted after a lower extremity arthroplasty between 1994 and 2001. Sample included 1361 patients with RA and 26,096 patients with OA. The main outcome measure was functional status gain as assessed by the functional independence measure (FIM). Our primary analytic method was linear regression. Covariates were age, gender, race/ethnicity, other comorbidity, admission FIM, and site of arthroplasty. Mean length of stay for patients with RA was 11.3 +/- 7.1 days (mean +/- standard deviation) versus 10.3 +/- 6.5 days for those with OA. Mean weekly gain was 18.6 +/- 12.1 for patients with RA versus 20.6 +/- 12.0 for those with OA. After adjusting for covariates, RA was associated with longer stay (0.7 day) and lower FIM gain (2.6). RA was associated with longer length of rehabilitation stay and lower FIM gain in patients with lower extremity arthroplasty. Such patients may require additional monitoring to ensure sufficient rehabilitation.
Kelley’s Textbook of reumatology. 17th edn
  • E D Haris
  • R C Budd
  • G S Frestein
Monitorowanie stanu pacjenta w chorobach reumatycznych (in Polish) Górnicki Wydawnictwo Medyczne
  • P Wiland
Effect on treatment with low temperatures on rheumatoid hand (in Polish)
  • K Księżpolska-Pietrzak
  • B Cygler
  • A Lesiak
  • M Noniewicz