Rehabilitation of Rheumatological Diseases

rheumatoid arthritis rehabilitation

Rheumatoid arthritis (RA) is a chronic inflammatory disease that mainly affects the joints. The goal in the treatment of RA is to achieve low disease activation and functional recovery, and to prevent structural damage. Disease activity, factors affecting the course of the disease, presence of additional disease, and safety should be considered when planning drug therapy in RA.

As drug therapy, the use of methotrexate (MTX) alone or in combination with other disease-modifying drugs is the first-line treatment. If MTX is contraindicated, sulfosalazine or leflunamide can be used. If there is no response to these treatments, biologic drugs may need to be started.

General principles in rehabilitation are patient education, preservation or improvement of functional status, prevention of disability and increasing quality of life.

Muscle weakness and loss of muscle mass are observed in RA as a result of high disease activity, inactivity, and changes in muscle metabolism. With the exercise program, it is aimed to protect or increase joint range of motion, increase muscle strength and endurance, increase joint function and increase aerobic capacity.

In patients with RA, it is aimed to reduce pain and swelling, to prevent or eliminate deformities by keeping the joint in a functional position with a splint or orthosis.

Assistive devices used to continue activities of daily living help increase the functional level of the patient, reduce the burden on the joints, and help the patient gain an independent position in the society.

Cold application is preferred to reduce pain and swelling in the joints. Heat application can reduce muscle tension and pain in patients whose systemic disease activity is under control. TENS therapy for pain can be effective. Electrical stimulation can be effective in reducing hand muscles, increasing hand grip strength and improving functions. Low-power laser therapy can be used to reduce pain and morning stiffness.


Ankylosing spondylitis (AS) is a chronic disease that characteristically involves the spine and can cause severe structural damage, functional loss, and decreased quality of life.

The first-line therapy in the treatment of AS is the initiation of non-steroidal anti-inflammatory drugs.

Physiotherapy and rehabilitation have a great place and importance in the non-drug treatment of AS. General goals in AS rehabilitation; to reduce pain, increase muscle strength and endurance, increase balance and physical condition, and minimize joint deformities.

Patients should be informed about the disease, especially in the early period, and they should be educated about maintaining proper posture, sleeping on a low pillow and an appropriate bed, not doing work by leaning forward for a long time, and doing regular daily exercise.

Apart from daily exercises, swimming positively affects aerobic capacity and lung functions. Sportive activities increase functional capacity, maintain joint range of motion, and increase muscular endurance.

Considering the sensitivity of the joint area and joint capsule tension, especially in inflammations at the tendon attachment sites, attention should be paid to excessive pain and injuries during stretching and endurance exercises.

Before exercise therapy, hot therapy and electrotherapy can be applied to increase tolerance and reduce symptoms.

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