Effect of functional exercises on patients with rheumatoid arthritis: a meta-analysis / 北京大学学报(医学版)

OBJECTIVE@#To evaluate the effect of functional exercises on disease activity, joint function and quality of life of patients with rheumatoid arthritis (RA).@*METHODS@#Randomized controlled trials were searched in Cochrane Library, PubMed, China National Knowledge Infrastructure (CNKI), VIP database and Wanfang database with keywords being "rheumatoid arthritis/RA", "function exercise (training)/joint exercise (training)/physical exercise (training)/resistance movement (exercise)/isotonic and isometric/stretching exercise/muscle exercise", and "trials/clinical trials". Then literature selection, extraction and literature quality evaluation were carried out by two of the authors independently following the including and excluding standards. Then the outcome indicators were analyzed with Review Manager 5.3 software.@*RESULTS@#In the study, 2 173 articles were achieved by searching in databases, including 1 522 English papers and 651 Chinese papers. Then 913 duplicated papers were identified and removed using EndNote software. After reading the titles and abstracts, 1 194 papers were excluded that did not satisfy the including standards. Finally, the full texts of these papers were read and papers with insufficient data were excluded, resulting in 13 included papers for systematic review, including 8 English and 5 Chinese papers. A total of 812 cases were studied in these papers, including 426 in the experimental groups and 386 in the conventional groups. For the outcome index in these articles, disease activity score 28 (DAS28) was used in 5 of them, health assessment questionnaire (HAQ) was used in 8 articles, visual analogue scale (VAS) for pain was used in 6 articles, and morning stiffness duration was used in 3 articles. The meta-analysis showed that functional exercises could delay the development of the disease activity of RA patients (mean difference=-0.76; 95%CI: -1.13, -0.38; P<0.001), improve the joint function (mean difference=-0.36; 95%CI: -0.47, -0.24; P<0.001), alleviate the pain of joints (mean difference=-1.75; 95%CI: -1.98, -1.53; P<0.001), and reduce the duration of morning stiffness (mean difference=-17.65; 95%CI: -22.09, -13.21; P<0.001).@*CONCLUSION@#This study showed the positive effects of functional exercises on alleviating the pain of joints, reducing the morning stiffness duration, and delaying the disease exacerbation of RA patients. It has a positive effect on improving the joint function and improving the quality of life in patients with RA.

Perfil clínico funcional de pacientes con artritis reumatoide derivados a Fisiatría en control en Centro Reumatólogico Avanzado (CREA) del Hospital Clínico Universidad de Chile / Functional clinical profile of patients with Rheumatoid arthritis derived to Physiatry in control at Centro Reumatólogico Avanzado (CREA) of Hospital Clínico Universidad de Chile

Rheumatoid arthritis (RA) is a systemic inflammatory disease that primarily affects the joints causing varying degrees of disability. Non-pharmacological management is increasing evidence of its usefulness impacting functionality. Objectives: To characterize the clinical / functional profile of patients with rheumatoid arthritis derived physiatrist assessment in the Clinical Hospital University of Chile. Methods: We reviewed the clinical records of patients with RA derivatives Physical Medicine, extraction demographics, medical history, physical examination and functionality. Statisticians analysis of central tendency, dispersion, absolute and relative frequencies. Results: 85 medical records were analyzed. 88.2% were women with an average age of 54.05 ± 11.42 years. 38.8% have at least one comorbidity. 34.1% of patients takes between 6 and 15 years of disease. The average drug related AR is 5.6 per patient, being more Disease Modifying Antirheumatic Drugs (DMARDs) found. 35.2% presented falls in the past year. Pain is a symptom found in the history and physical examination with a VAE (venous air embolism) 4.4 ± 2.43 at the time of consultation and 6.7 ± 3.3 in crisis. 20% received kinesic therapy and only 7% occupational therapy. 45.3% of patients having a value of HAQ (health assesment questionnaire) who scored as moderate disability, even if their selfperception of independence reaches 65.9%. Conclusion: The analysis allows us to perform a demographic, clinical and functional profile that allows us to guide rehabilitation actions. (AU)

Fisioterapia na qualidade de vida de indivíduos com artrite reumatoide: revisão sistemática / Physiotherapy on quality of life of patients with rheumatoid arthritis: systematic review

Introdução: a artrite reumatoide é uma doença reumática inflamatória que causa alterações musculoesqueléticas importantes, interferindo diretamente na qualidade de vida dos indivíduos acometidos. A fisioterapia destaca-se pela sua segurança e evolução apresentada. Objetivo: verificar os efeitos da fisioterapia na qualidade de vida de indivíduos com artrite reumatoide. Materiais e Métodos: realizou-se uma revisão sistemática na base de dados PubMed, a partir dos descritores Rheumatoid Arthritis, Quality of Life e Physical Therapy Specialty, do período de 2009 a 2015. Resultados: encontraram-se 84 artigos. Inicialmente 15 artigos potencialmente relevantes foram selecionados para o estudo, e, após uma análise qualitativa criteriosa, selecionaram-se 06 artigos completos que preencheram os critérios de inclusão exigidos. Conclusão: os estudos indicam que há uma variedade de métodos terapêuticos que possibilitam o manejo da patologia e que a aderência do indivíduo ao protocolo interventivo torna-se indispensável para o sucesso do tratamento fisioterapêutico na qualidade de vida em indivíduos com artrite reumatoide.

Introduction: rheumatoid arthritis is an inflammatory rheumatic disease that causes significant musculoskeletal changes, directly interfering with quality of life of affected individuals. Physiotherapy stands out for its safety and presented evolution. Aim: to verify the effects of physiotherapy on quality of life of individuals with rheumatoid arthritis. Materials and Methods: the authors conducted a systematic review in PubMed database from descriptors Rheumatoid Arthritis, Quality of Life and Physical Therapy Specialty, the period from 2009 to 2015. Results: 84 articles met. Initially 15 potentially relevant articles were selected for the study, and after a careful qualitative analysis, we selected 06 complete articles that met the required inclusion criteria. Conclusion: studies indicate that there are a variety of therapeutic methods that enable management of the condition and that the adherence of the individual to the interventional protocol is indispensable to the success of physiotherapy on quality of life in individuals with rheumatoid arthritis.

Terapia ocupacional na artrite reumatoide: o que o reumatologista precisa saber? / Occupational therapy in rheumatoid arthritis: what rheumatologists need to know?

Intervenções voltadas para a educação e o autogerenciamento da artrite reumatoide (AR) pelo paciente aumentam a adesão e a eficácia da abordagem precoce. A combinação de tratamento medicamentoso e tratamento de reabilitação visa a potencializar as possibilidades de intervenção, retardar o aparecimento de novos sintomas, reduzir incapacidades, minimizar sequelas e reduzir o impacto dos sintomas sobre a funcionalidade do paciente. A terapia ocupacional é uma profissão da área da saúde que objetiva a melhoria do desempenho de atividades pelo paciente e fornece meios para a prevenção de limitações funcionais, adaptação a modificações no cotidiano e manutenção ou melhoria de seu estado emocional e participação social. Devido ao caráter sistêmico da AR o acompanhamento multidisciplinar é necessário para o adequado manejo do impacto da doença sobre os mais diversos aspetos da vida do paciente. Como membro da equipe de saúde, o terapeuta ocupacional objetiva a melhoria e manutenção da capacidade funcional do paciente, prevenir o agravamento de deformidades, auxiliar o processo de compreensão e enfrentamento da doença, fornecer meios para as atividades necessárias para o engajamento do indivíduo em ocupações significativas, favorecer sua autonomia e independência em atividades de autocuidado, laborais, educacionais, sociais e de lazer. O objetivo desta revisão é familiarizar o reumatologista com as ferramentas de avaliação e intervenção usadas na terapia ocupacional, com enfoque na aplicação desses princípios para o tratamento de pacientes com diagnóstico de AR.

Interventions focusing on education and self-management of rheumatoid arthritis (RA) by the patient improves adherence and effectiveness of early treatment. The combination of pharmacologic and rehabilitation treatment aims to maximize the possibilities of intervention, delaying the appearance of new symptoms, reducing disability and minimizing sequelae, decreasing the impact of symptoms on patient's functionality. Occupational therapy is a health profession that aims to improve the performance of daily activities by the patient, providing means for the prevention of functional limitations, adaptation to lifestyle changes and maintenance or improvement of psychosocial health. Due to the systemic nature of RA, multidisciplinary follow-up is necessary for the proper management of the impact of the disease on various aspects of life. As a member of the health team, occupational therapists objective to improve and maintaining functional capacity of the patient, preventing the progression of deformities, assisting the process of understanding and coping with the disease and providing means for carrying out the activities required for the engagement of the individual in meaningful occupations, favoring autonomy and independence in self-care activities, employment, educational, social and leisure. The objective of this review is to familiarize the rheumatologist with the tools used for assessment and intervention in occupational therapy, focusing on the application of these principles to the treatment of patients with RA.

Prática de atividade física entre pacientes da Coorte Brasília de artrite reumatoide inicial / Physical activity among patients from the Brasília cohort of early rheumatoid arthritis

INTRODUÇÃO: O Consenso 2012 da Sociedade Brasileira de Reumatologia para Tratamento da Artrite Reumatoide (AR) recomenda que os pacientes realizem exercícios físicos de forma regular. Não há estudos no Brasil sobre a prática de atividade física entre pacientes com AR inicial. OBJETIVO: Investigar a prática de atividade física entre pacientes com AR inicial e a possível relação entre atividade física, atividade da doença e incapacidade funcional. MÉTODOS: Estudo transversal incluindo pacientes da Coorte Brasília de AR inicial. Foram analisados dados demográficos (sexo, idade e escolaridade), prática de atividade física, índice de atividade da doença (Disease Activity Score 28 - DAS 28), incapacidade funcional (Health Assessment Questionnaire - HAQ), além de dados sobre tabagismo, etilismo, presença de comorbidades e tratamento da AR. RESULTADOS: Foram avaliados 72 pacientes, sendo 90,27% do sexo feminino, com média de idade de 50,2 ± 13,3 anos, média do DAS 28: 3,66 e a do HAQ: 0,69. Estavam regularmente ativos 43,05%, sendo que a caminhada foi o exercício mais praticado (80,64%). A média de tempo de exercício físico foi de 48,22 ± 27,18 min, periodicidade de 3,7 ± 1,64 vezes na semana. Não houve associação entre atividade física com sexo, idade, escolaridade, atividade da doença, incapacidade funcional, tabagismo ou etilismo, presença de comorbidades e tratamento com drogas modificadoras do curso da doença. CONCLUSÃO: Dada a importância da prática regular de atividade física, há necessidade de orientação dos pacientes, em especial quanto à prática de atividades resistidas, pouco frequente entre os pacientes do nosso estudo.

INTRODUCTION: The 2012 Consensus of the Brazilian Society of Rheumatology (SBR) for the treatment of Rheumatoid Arthritis (RA) recommends that patients should regularly perform physical exercises. There have been no studies in Brazil on physical activity among patients with early RA. OBJECTIVE: To investigate the physical activity practice among patients with early RA and the possible association between physical activity, disease activity and functional disability. METHODS: Cross-sectional study of patients from the Brasilia cohort of early RA. Demographic data (sex, age and level of schooling), physical activity practice, Disease Activity Score 28 (DAS 28), functional disability (Health Assessment Questionnaire - HAQ), as well as data on smoking status, alcohol consumption, comorbidities and RA treatment were analyzed. RESULTS: A total of 72 patients were evaluated, 90.27% females, mean age 50.2 ± 13.3 years, mean DAS 28: 3.66 and HAQ: 0.69. Of them, 43.05% were regularly active, with walking being the most often practiced exercise (80.64%). The mean duration of exercise was 48.22 ± 27.18 min, with a frequency of 3.7 ± 1.64 times per week. There was no association between physical activity and gender, age, educational level, disease activity, functional disability, alcoholism or smoking, presence of comorbidities and treatment with drugs that alter the course of disease. CONCLUSION: Given the importance of regular physical activity practice, it is necessary to recommend it to patients, especially resistance physical activities, which are not frequent among the patients in our study.

Artrite reumatóide e exercício físico: resgate histórico e cenário atual / Rheumatoid arthritis and physical exercise: historical research and current scenario

A Artrite Reumatóide (AR) é considerada uma doença inflamatória crônica, de origem auto-imune e etiologia desconhecida. Além do tratamento fisioterápico e farmacológico, fortes evidências apontam benefícios no uso de exercícios físicos (EF) na sua terapêutica. Porém, ainda não existe consenso quanto ao melhor tipo, intensidade, freqüência e duração. O presente estudo de revisão teve por objetivo realizar um resgate histórico da interpretação e tratamento da doença e expor uma perspectiva atualizada da prescrição de EF para portadores de AR. A seleção das publicações foi realizada a partir das bases de dados Web of Science e Pubmed Central. Outros artigos foram eventualmente incluídos para fortalecer e aprimorar a discussão. Sob a luz da literatura revisada, a terapia com fármacos, repouso e Crisoterapia parecem ter sido a base do tratamento no século passado. Os EF, já mencionados nos primeiros anos de estudos, permanecem até hoje como parte da terapêutica e se configuram cada vez mais como protagonistas na história do controle da AR. É possível admitir que, embora não exista consenso com relação a um protocolo ou programa padrão de EF, existem pontos de comum acordo entre autores que podem ser assumidos como norteadores na confecção de programas terapêuticos para o tratamento da AR. Parece ser fundamental no tratamento da doença que a prática regular de EF seja incluída na rotina da vida diária do paciente o que, em conjunto com a terapia farmacológica, pode proporcionar maior independência e qualidade na vida dos portadores de AR.

The Rheumatoid Arthritis (RA) is considered a chronic inflammatory disease, of autoimmune origin and unknown etiology. Besides the physical therapy and the pharmacological treatment, strong evidences point out to the benefits of the use of physical exercises (PE) in its treatment. However, there is still no consensus regarding the best type, intensity, frequency and duration. The aim of the present study was to perform a historical research of the interpretation and therapeutics of the disease and to expose an up to date perspective of the prescription of PE in the treatment of RA. The selection of these publications was performed on the Web of Science and Pubmed Central data basis. Other articles were eventually included to strengthen and improve the discussion. Regarding the revised literature, the pharmacological therapy, rest and Crisotherapy were the basis for the treatment of the disease. The PE, already mentioned in the first years of study remain until this day as a part of the therapy and seem to be increasingly important in the history of the control of the RA. It is possible to admit that, even though there is no consensus regarding a protocol or a standard program of PE, there are points in which many authors agree, that may be assumed as references in the creation of therapeutic programs for the treatment of RA. It seems to be fundamental in the treatment of the disease that the regular practice of PE is included in the daily routine of the patient, which, along with the pharmacological therapy, may provide a greater independence and quality of life to the people with RA.

Efeitos da reabilitação aquática na sintomatologia e qualidade de vida de portadoras de artrite reumatóide / Effects of aquatic rehabilitation on symptoms and quality of life in rheumatoid arthritis patients

A artrite reumatóide (AR) tem manifestações articulares e extra-articulares, afetando diretamente a qualidade de vida dos pacientes. A hidroterapia é um recurso muito utilizado na reabilitação desses pacientes...

Rheumatoid arthritis (AR) has both joint and extra-joint manifestations and may directly affect patients' quality of life. Hydrotherapy is a very useful resource for treating RA due the water physical properties and physiological effects...

Tratamientos no farmacológicos / non-farmacological treatment

Las medidas terapéuticas no farmacológicas complementan el tratamiento de la artritis reumatoidea (AR) y tienen como objetivo colaborar en el control de la inflamación, contribuir a reducir o aliviar el dolor, prevenir o mejorar la movilidadarticular y mantener una adecuada capacidad funcional en los pacientes con AR. Los pilares del tratamiento de rehabilitación son: los ejercicios terapéuticos, la protección articular y la fisioterapia. La terapia de ejercicios es considerada como una parte fundamental del tratamiento de la AR en todos los estadios dela enfermedad. El ejercicio tiene como objetivos preservar y recuperar la capacidad funcional al mejorar la movilidad articular, fuerza muscular, resistencia y capacidad aeróbica. Existen varios elementos ortésicos como valvas, férulas, plantillas que permiten la protección de algunas articulacionesen pacientes con AR. No hay evidencia concluyente que la fisioterapia tenga eficacia en AR para mejorar la clase funcional. Comunicaciones aisladas y con poco número de pacientes han mostrado un efecto beneficioso de estos sobre el dolor, sin evidencia de efecto sobre la inflamación. Cerca de un 50 por ciento de pacientes con AR utilizan o han utilizado tratamientos alternativos. Es importante destacar que este tipo de tratamientos están fuera de la indicación científica rigurosa pero aún así pueden ser seguros y efectivos o bien inefectivos e inseguros. La característica que define a los tratamientos alternativos es la falta de sustento metodológico científico.

Programas de proteção articular para indivíduos com artrite reumatóide: uma revisão da literatura / Joint protection programs for individuals with rheumatoid artritis: review of literature

A artrite reumatóide (AR) é uma desordem crônica e sistêmica. Apresenta períodos de remissão e exacerbação de sinovite simétrica, atingindo, com freqüência, pequenas articulações. Os programas de proteção articular (PA) visam à manutenção da integridade articular, da habilidade funcional e redução da dor. Com o objetivo de abordar a relevância dos programas de PA, foi realizado um levantamento bibliográfico na base de dados Medline, entre 1966 a 2007. Foram identificados 64.001 estudos e 8 foram selecionados. Foram utilizados como critérios: população com AR, randomização para a seleção de participantes, descrição da metodologia de PA, critérios analisados por técnicas mensuráveis, registro de análise pré e pós aplicação da PA. Os estudos foram agrupados em 3 aspectos: caracterização da população, da intervenção e os desfechos. Buscou-se enfatizar as metodologias empregadas no desenvolvimento desses programas a fim de iniciar a sistematização da aplicação de PA. Há características recorrentes na maioria dos programas analisados, tais como utilização de grupos, fomentação de discussões, atuação de terapeutas ocupacionais e temas como AR e princípios de PA, o que fundamenta a sua aplicação no planejamento de futuros programas de PA...

Rheumatoid Arthritis (RA) is a chronic and systemic disease with periods of remission and exacerbation of symmetric synovium reaching frequently the small joints. The joint protection programs (JPP) aim to maintain the joint integrity, the functional skills and reduction of pain. There was realized a survey of bibliography based on Medline between 1966 and 2007. There were identified 64.001 studies and 8 were selected, using the following rules: population with RA randomized for selection, description of the methodology of joint protection (JPP) , analyzed rules for techniques of the register pre and pos application of JPP. The studies were classified in 2 aspects: characteristics of the population and intervention. There are characteristics in most of the analyzed programs such as the use of groups, the promoting of discussion, the performance of occupational therapists and topics like RA and the principles of JPP which is the base of the application of the future programs of joint protection...

The Effect of Tai Chi Movement in Patients with Rheumatoid Arthritis / 간호학회지

PURPOSE: This study was performed to verify the effect of Tai Chi exercise on patients with rheumatoid arthritis particularly their level of pain, fatigue, sense of balance and daily life performance (ADL). METHOD: It employed a non-equivalent control group pre- and post-test design. The research instruments used in this study were pain, fatigue, sense of balance and ADL. Thirty-two patients in the experimental group carried out 50 minutes of Tai Chi exercise for 12 weeks, and 29 patients in the control group did not. Before and after the experiment, both groups were tested for pain, fatigue, sense of balance and ADL. Collected data were processed using the SPSS/WIN 10.0 program analyzed by the frequency, percentage, X2-test, and t-test. RESULTS: Pain and fatigue significantly decreased in the experimental group. However the improvement in ADL of the rheumatoid arthritis patients was not statistically significant but their sense of balance was enhanced significantly. CONCLUSION: Tai Chi exercise is an effective nursing intervention that can be used for rheumatoid arthritis patients.

Biologic effects of serum amyloid A in rheumatoid arthritis

A-SAA closely reflects measures of disease activity in patients with inflammatory arthritis. A-SAA, like TNF; can induce many of the proinflammatory activities associated with pannus formation and joint destruction in inflammatory arthritis.

Utilization characteristics of health care service for rheumatoid arthritis patients in Korea

The purpose of this study was to determine the factors which were responsible for delaying early diagnosis and optimal management of rheumatoid arthritis (RA) in Korea. We interviewed 109 outpatients diagnosed as RA being treated by rheumatologists, and we eventually analyzed 98 patients' data. The median length of time from symptom onset to the first visit to a medical doctor, to diagnosis, and visiting a rheumatologist were 8 weeks, 23 weeks, and 42 months respectively. The subspecialist with whom the patients consulted with for the longest time before visiting a rheumatologist were an orthopaedic surgeon for 51 patients, a Chinese herbal doctor for 19 patients, and a pharmacist for 16 patients. For early diagnosis and optimal management of RA in Korea, we believe that it is necessary to reduce the use of unconventional medical services such as Chinese herbal medicine and nonprescribed medication, and to emphasize rheumatologic and rehabilitative care in the early stage.

Rehabilitación dental con implantes oseointegrados en pacientes con sindrome de Cushing, artritis reumatoidea y osteoporosis asociada / Dental rehabilitation with osseointegrated implants in patient with Cushing's syndrome, rheumatoid arthritis and related osteoporosis

Siempre que se diagnostica sindrome de Cushing o artritis reumatoide en un paciente, la inclinación más generalizada es contraindicar cualquier tratamiento en el que se involucren estructuras óseas por la presencia de osteoporosis asociada. El presente artículo es un caso clínico en el cual se comprueba lo relativo de este criterio, ya que a pesar de los antecedentes, la oseointegración de los implantes fue total