Rheumatoid arthritis is a chronic, autoimmune inflammatory disease that strikes the connective tissue of multiple joints of the body like spine , shoulders , hip , knees, ankles, wrists and fingers.
It can also affect the internal organs like heart, lungs and kidneys. It can affect only one joint (Monoarthritis) or inflammation can affect several joints (Polyarthritis). Arthritis can be symmetrical when it affects two joints simultaneously, such as the knees.
Although the causes of the disease, which affect women twice as much as men between 50 and 70 years old, and the resources for a definitive cure are not fully known, it is possible to reduce symptoms and preserve functional capacity Of patients with pathology . To know how, we need, first of all, to understand the picture more deeply.
Understanding Rheumatoid Arthritis
A typical feature of joint inflammation of rheumatoid arthritis is the involvement of synovium (fluid-filled tissue located in the center of the joints), which has the function of reducing friction between bones, as a kind of lubricating oil.
The American College of Rheumatology has established criteria for Rheumatoid Arthritis. In order to close the diagnosis, the patient must have at least four of the seven criteria below :
1- Morning stiffness: stiffness of the joints when waking up with duration of at least 1 hour.
2- Arthritis in at least 3 joints simultaneously.
3- Arthritis of hands and wrists
4- Symmetrical arthritis
5- Subcutaneous nodules
6- Positive rheumatoid factor (RF) in blood test.
7- Typical changes of RA in hand and wrist radiographs
Of these seven criteria, one to four should be present for at least 6 weeks. These criteria are only for patients with fully established disease. As has been said, at the beginning of the table, these findings may not be present.
Rheumatoid Arthritis Treatment: Medications
Drug therapy is the main treatment of rheumatoid arthritis. There are four different classes of drugs that can be used, depending on the severity of the case:
- Non-steroidal anti-inflammatory drugs;
- Disease-modifying antirheumatic drugs;
- Biological response modifiers;
Pulse therapy is a medical practice, usually at times of "seizures" or "outbreaks" of the disease. It is a strong immunosuppression that has as main objective to neutralize the effects of the disease, seeking the stabilization of the crisis. It is the administration of high doses of corticoid, through the vein. For a short time. The corticoid used in Pulmonotherapy is Solumedrol (Methylprednisolone) the dose varies from 1000 mg / day in 3 days or 5 days.
Heat in the treatment of rheumatoid arthritis should be adopted when there is acute pain and signs of inflammation. Promoting pain relief and relaxation of muscles. The measurement is especially indicated for treatments performed in the morning or on colder days, periods in which the muscles tend to become more tense, aggravating the symptoms.
Already the use of ice , in turn, is also a good alternative for the relief of pain caused by rheumatoid arthritis.However, it should only be employed after strenuous exercise practice, which should be avoided whenever possible.
Non-medicated treatment includes controlled physical exercise, physical therapy and nutritional counseling to avoid overweight and control cholesterol.
The importance of Physiotherapy in the treatment of rheumatoid arthritis is also due to postural reeducation (GPR can help with that) , improvement of muscle and joint function and increased strength and flexibility, which is achieved by performing specific and individualized exercises. During the physiotherapeutic treatment, passive joint mobilization in each joint affected by the disease is indispensable.
It should also be remembered that, while exercises are important and necessary, they should not become strenuous. The activities must be carried out only with medical indication and the advice of a specialized professional .
Pilates in Rheumatoid Arthritis
Pilates provides an increase in strength in the center of the body , improving balance, postural control, prevents pain and helps in improving daily movements and coordination. In addition, the exercises are low impact on the joints and improve mobility. In this way, day-to-day movements become more efficient.
The method works with stretching and body alignment exercises , providing joint muscle strengthening and adequate flexibility gain, avoiding excessive movement and favoring moderate loads.
In the period of peak symptoms, the objectives of the classes should be focused on joint mobilization, maintaining care to avoid fatigue and joint overload. The student will perform the exercises slowly so that the symptoms do not intensify.
When the pains and swellings decrease after the crisis period, the prescription of Pilates exercises can progress gradually, without exaggeration, with the possibility of performing also at that moment the muscular balancethrough the strength and flexibility of the debilitated muscles , so that The joints are preserved. In addition, we must work the body awareness, preparing the individual for daily activities. - since body awareness work, coupled with physical capabilities in a balanced body structure, results in a more economical and efficient movement pattern, avoiding excessive energy expenditure thus protecting the joints during the activities of daily living.
The exercises are performed with springs that promote a progressive resistance to the movement, always starting with lower loads, respecting the threshold of pain and range of motion. The use of springs associated with axial stretching minimizes joint compression and overload, thus allowing a safe muscular strengthening work.
Pilates goals: to restore joint mobility, improving lubrication by reducing stiffness, maintaining functional and stable joint avoidance of deformities, reduction of muscle retraction, postural reeducation, body awareness and training of ADLs.
For this we can work on Pilates: exercises that promote mobility and flexibility for tight muscles and joints with ADM restriction (stretching), muscle strengthening that can start with isometric exercises evolving to the eccentric, corrective exercises for the patterns of functional movements. It can evolve to more challenging exercises always respecting the phases of the disease.
During acute attacks, classes should be adjusted or suspended until the responsible health professional is released.
The patient who has rheumatoid arthritis should always be looking to improve his condition, and Pilates can be a great ally in the search for treatments, because it strengthens the muscles needed to treat them.
It is also very important that there is a knowledge of the health professional and, more important, a feedback between the student and the instructor regarding the sensation of the exercises, facilitating the adaptation of a correct program of exercises .