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TRATAMENTUL RECUPERATOR IN BOLILE REUMATISMALE
POLIARTRITA REUMATOIDA
Codrina ANCUTA MD, PhD, sef lucrari
Reumatologie-Balneofizioterapie
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Plan de lucru Definitie PR Tablou clinic Deficite functionale caracteristice PR
Suport etiopatogenic Mana reumatoida Picior reumatoid
Evaluare PR Tratament medicamentos, chirurgical si de
recuperare in PR
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Poliartrita reumatoida
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Clinic
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ASPECTE PARTICULARE Aspecte particulare – deficite functionale
Mana reumatoida Coafarea stiloidei cubitale Degete fuziforme Degete in gat de lebada Degete in butoniera, M Police in Z Mana in dos camila, baioneta
Picior reumatoid Halux valgus, degete in ciocan Picior triunghiular, rotund, complex
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Mana reumatoida
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Picior reumatoid
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Afectare membru inferior
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CLASIFICARE FUNCTIONALA STEINBROKER
Clasa I – capacitate de a desfasura ADL fara durere, limitare
Clasa II- cu oarecare durere
Clasa III. Limitarea ADL prin durere, afectare functionala
Clasa IV = dependent de carut
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DEFICITE FUNCTIONALE Initial, precoce - Durere si inflamatie In evolutie – Distructie articulara, deformari articulare,
afectare functionalaArticular & muscular
Distructie articulara Deformari articulare Limitare mobilitate articulara anchiloza Afectare prehensiune – forta/ finete Afectare mers si ortostatism Afectare forta musculara
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OBIECTIVE TERAPEUTICE Scaderea activitatii bolii
remisiune Clinic (durere, inflamatie,
redoare) Biologica (scadere VSH,
CRP) Functionala (mentinere/
ameliorare deficit functional)
Radiologica (absenta progresiei leziuni specifice)
Tratament medicamentos remisive imunosupresoare biologice Corticoterapie AINS, antalgice
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OBIECTIVE RECUPERARE Diminuarea durerii si inflamatiei Cresterea amplitudinii de miscare Cresterea fortei si a endurantei musculare Mentinerea/ Ameliorare/ maximizarea functionala
articulara Prevenirea/ minimizarea dizabilitatii si afectarii
functionale Preventia/ corectarea deformarilor articulare Promovarea independentei
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TERAPIA FIZICALA Electroterapie
Joasa, medie si inalta frecventa Electrostimulare antalgica, pt cresterea fct musc Rol: antalgic, antiinflamator, rezorbtiv, trofic, mentinere tonus musc Articulatia afectata, 1 sed/zi, zilnic, 10 zile Se evita in puseul acut! rectangular, galvanic (ionizare, bai galvanice 2/4 celulare), interferential,
ultrasonografia! Laserterapie
Pe puncte dureroase Hidroterapia/ balneoterapia – contraindicata in puseu!!!; eventual in
formele cronice cu distructii articulare importante
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KINETOTERAPIA Obiective:
Mentinerea/Cresterea mobilitatii articulare mentinerea/Ameliorarea functiei musculare Mentinerea/cresterea capacitatii functionale Membrul superior:
Mentinerea / reeducarea prehensiunii de forta si finete Membrul inferior
Stabilitatea si mobilitatea articulara/ mersul Evaluare frecventa a afectarii functionale si progresiei PR Exercitii de coordonare motorie, dexteritate mana si
degete, coordonare ochi-mana-picior
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DISPOZITIVE AJUTATOARE
Pt mers – carje, baston Pt activitatile cotidiene (ADL-uri) Orteze – statice/dinamice Splint-uri ot degete, pumn Orteze genunchi Colier cervical = subluxatie C1-C2