SPONDYLOARTHROPATHIES - CLINICAL EVALUATION AND PHYSICAL THERAPY

Broj: 2, 2004 Rubrika: Uvodno predavanje Autori: Tonko Vlak

Spondiloartropatijama nazivamo skupinu heterogenih, kroničnih, autoimunih reumatskih bolesti gdje spadaju ankilozantni spondilitis, reaktivni artritis, psorijatički artritis i artritisi povezani s upalnim crijevnim i očnim bolestima. Iako se radi o klinički, međusobno bitno različitim entitetima, ova velika skupina bolesti ima brojna zajednička klinička, radiološka i genetska obilježja, kojima se jasno razlikuje od ostalih upalnih reumatskih bolesti. Jedan od najvažnijih pristupa u praćenju bolesnika sa spondiloartropatijom jest kontrola i praćenje njihovog funkcijskog statusa i općeg zdravlja, što se najlakše postiže korištenjem brojnih, bolesti prilagođenih upitnika, Oni uvažavaju sve promjene na lokomotornom sustavu i zahvaćenim zglobovima, stavljajući te promjene u odnos spram drugih dimenzija zdravlja (psihički status, socijalni status, emocionalni status, aktivnosti dnevnog življenja). Pri tome se najčešće koriste:

1. S-HAQ prilagođeni HAQ upitnik za bolesnike sa spondioloartritisom;
2. DFI funkcijski indeks za ankilozantni spondilitis;
3. Leeds upitnik o ometenosti, koji uključuje funkcijske parametre i držanje bolesnika s ankilozantnim spondilitisom;
4. BASFT upitnik za aktivnosti dnevnog življenja.
Fizikalna terapija je jedan od najkorisnijih terapijskih pristupa u rehabilitacijskom postupku i liječenju bolesnika sa spondiloartropatijom, poglavito kinezioterapija. Uz taj oblik fizikalne terapije koristi se i čitav niz ostalih procedura, koje značajno upotpunjuju korisno djelovanje medicinske gimnastike (ultrazvuk, krioterapija, elektroterapija, laser…) na povećanje funkcijskog kapaciteta lokomotornog statusa.

Spondyloarthropathy is a group of chronic autoimmune disorders including ankylosing spondylitis, reactive arthritis, psoriatic arthritis, arthritis associated with inflammatory bowel disease, acute anterior uveitis and undifferentiated spondyloarthropathies. The spondyloarthropathies share common clinical, radiological, and genetic features that are clearly distinct from other inflammatory rheumatic diseases. The major goal in the management of patients with rheumatic disorders is to control or cure the disease and to preserve and control function and health status. To measure treatments’ efficacy standardized assessment of organ morphology, function, and of health status are required. The instruments for measuring health status or quality of life cover a variety of dimensions of health, including physical, social, and emotional functioning. Measurements used to evaluate the efficacy of treatments in ankylosing spondylitis include spinal and chest movement, duration and severity of morning stiffness, and quality of sleep. Health status indices such as the HAQ or AIMS are not readily applicable to spondyloarthropaties. It is reason to use some others:
1. Functional status measure S-HAQ for patients with spondylitis by adding five items to the HAQ, to cover the activities identifi ed as most problematic;
2. Functional index for the assessment of ankylosing spondylitis (Dougados Functional Index – DFI) – it is valid and reliable and shows suffi cient responsiveness; S-HAQ appears at least as sensitive to change as the Dougados Index;
3. The Leeds Disability Questionnaire assesses disability in ankylosing spondylitis, inquiring about four areas of function: mobility, bending down, reaching up and neck movements, and postures;
4. The Bath Ankylosing Spondylitis Functional Index (BASFI) 10 item self-administered questionnaire to assess function and activities of daily living in patients with ankylosing spondylitis.
Physical therapy is one of the most important way to restore function and health status in patients with spondyloarthropathies, esspecially individual kinesitherapy. We use and many other procedures combine them with kinesitherapy (ultrasound, cryotherapy, electrotherapy, laser …).

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