Nefarmakološko liječenje osteoartritisa utemeljeno na dokazima

Osteoarthritis (OA ) is the most common rheumatic joint disease, but also a disease that affects the entire joint and all structures surrounding the joint (periarticular structures). Literature dealing with this topic most commonly includes results related to the treatment of knee osteoarthritis (OA ), while other localisations of degenerative changes of the joints are not researched in such a detailed way. In addition to that, these degenerative changes exhibit less evidence strength, so the same will be used in this review. According to the latest 2019 ESCEO guidelines for the treatment of OA , non-pharmacological treatment (NPT) has an important role in OA treatment and it is a part of all OA treatment algorithms, and it has to be a part of evidence-based medicine (EBM). With technological progress in rehabilitation medicine, new solutions have appeared, as well as new forms of NPT aimed at helping patients, relieving pain, increasing the patients’ functional ability and improving their quality of life. Due to this, in this literature review, which was accessed through the Cochrane library, PEDro database and PubMed search, we mostly found discussions about new technologies in OA treatment. During that search, we can easily conclude that results of many systematic reviews and meta-analyses about the use of conventional methods of physical therapy did not change much compared to the methods used 10 years ago. When it comes to all of these methods, medical exercise is considered to be the most effective one, with the highest evidence strength. Nowadays, as opposed to literature sources in the past, in most literature we are able to find a significantly more accurate and precise definition of the term “physical activity”. It is defined as an activity performed during an individual’s stay at their workplace, during transport, while doing one’s chores or housework, and during leisure time. We believe that the newest, modern technologies in rehabilitation medicine, such as the following ones: high-intensity laser therapy (HILT ), extracorporeal shock wave therapy (ESWT), radio frequency (RF) and electromagnetic therapy super inductive system (SIS ), present the biggest challenge in the NPT of OA today. These treatment methods, according to the available EBM data, have shown outstanding efficiency in the treatment of OA by reducing the patients’ pain, improving patients’ functional ability as well as their quality of life, with minimal adverse effects. Today, the general opinion is that we should give advantage to modern technologies in combination with already well- known and defined medical exercises with implementing preventive activitieOsteoartritis (OA ) najčešća je reumatska bolest zgloba i svih okolozglobnih struktura. U literaturi su najčešće zastupljeni rezultati vezani uz liječenje OA koljena, a ostale lokalizacije degenerativnih promjena zglobnih struktura manje su istraživane. Pritom su i dokazi manje snage pa će tako biti i u ovome preglednom članku. Prema ažuriranim smjernicama ESCEO-a iz 2019. g., bitnu ulogu u liječenju bolesnika s OA ima i nefarmakološko liječenje (NFL) – dio svih algoritama liječenja OA , uz preporuku da mora biti utemeljeno na dokazima (EBM). Tehnološki napredak u rehabilitacijskoj medicini nudi neka nova rješenja, nove oblike NFL-a radi pomoći bolesnicima, uklanjanja boli i povećanja funkcionalnih mogućnosti, čime se poboljšava i kvaliteta života. Zbog toga se u literaturi koja je dostupna pregledom Cochraneove knjižnice, baze PEDro i tražilice PubMed danas najčešće raspravlja o novim tehnologijama u liječenju OA . Primjećujemo da se rezultati brojnih sustavnih pregleda i metaanaliza o primjeni konvencionalne fizikalne terapije nisu bitno promijenili u odnosu prema onima u sličnim analizama i prije 10-ak godina. Najučinkovitijom metodom, uz najkvalitetniju snagu dokaza, smatra se medicinska vježba. No, za razliku otprije, danas u literaturi nalazimo znatno točniju i precizniju definiciju pojma tjelesne aktivnosti: to je aktivnost tijekom boravka na radnome mjestu, za vrijeme transporta, tijekom obavljanja kućanskih poslova i u slobodno vrijeme. Najveći izazov u NFL-u OA danas jesu moderne tehnologije u rehabilitacijskoj medicini, a to su terapije laserom visokog intenziteta (HILT ), udarnim valom (ESWT), radiofrekvencijom (RF) i elektromagnetskim poljem visokog intenziteta (SIS ). Te metode liječenja, prema dostupnim podatcima EBM-a, pokazale su izrazitu učinkovitost u liječenju OA : reduciranu bol kod ispitanika, poboljšane funkcionalne sposobnosti i kvalitetu života bolesnika. Sve to uz izrazito malo neželjenih događaja. Danas je uvriježeno mišljenje da treba davati prednost modernim tehnologijama, dobro definiranim medicinskim vježbama i provođenju preventivnih aktivnosti

Patophysiology of osteoarthritis

Osteoartritis (OA) je kronična, polagano progredirajuća bolest zglobne hrskavice i okolozglobnih struktura, koju karakterizira postepen nastanak zglobne boli, ukočenosti zgloba i ograničenost pokreta. Muskuloskeletne bolesti su jedan od vodećih medicinskih, socijalnih i ekonomskih problema današnjice, a upravo je OA najučestalija među njima, karakteristična po svojoj incidenciji i utjecaju na promjenu kvalitete življenja. Zbog toga u reumatologiji postoji veliki interes za sve aspekte te bolesti, a poglavito za patofiziologiju OA. Namjera ovog članka je bila da sagleda najvažnije aspekte patofiziološkog događanja u zglobu, jer poznavanje patofiziologije nam omogućava ispravno promišljanje terapijskih postupaka i farmakoterapije OA, usmjerenih na prevenciju, smanjenje simptoma i liječenje posljedica OA.Osteoarthritis (OA) is slowly evolving disease of articular cartilage degneration characterized by the gradual development of joint pain, stiffness and limitation of motion. Musculoskeletal diseases are growing medical, social and economic problem. OA among them takes leading position with incidence, morbidity and poor quality of life. In the last few decades there is increasing interest for better knowledge of all aspects of the disease, especially with regard to its pathophysiology. This paper focuses the recent aspects of patophysiology of OA, because knowledge of patophysiology means the challenge for the clinician to find a way to best prevent articular cartilage degradation, preserve joint function, treat joint pain and treat concurrent inflammation

Spondyloarthropathies - clinical evaluation and physical therapy

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 identified as most problematic; 2. Functional index for the assessment of ankylosing spondylitis (Dougados Functional Index - DFI) - it is valid and reliable and shows sufficient 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...)

Non-pharmacological treatment of osteoporosis

Kompleksnost uzroka, patofiziologije i kliničke slike osteoporoze (OP) razlog je i posljedično kompleksnog liječenja bolesti. Stoga, osim farmakoterapije, u procesu liječenja OP-a veliku ulogu ima i prevencija i nefarmakološko liječenje. Pri tome najviše mislimo na liječenje najteže posljedice bolesti – prijeloma. U tu svrhu koriste se različiti oblici fizikalne terapije i različiti rehabilitacijski modeli usmjereni na smanjenje bola i povećanje funkcijskih mogućnosti bolesnica. Spomenutim metodama treba pridodati i korištenje različitih funkcijskih pomagala, koja značajno olakšavaju aktivnosti dnevnog življenja.The complexity of causes, pathophysiology and clinical picture of osteoporosis (OP) have been the reasons of consequently complex treatment of the disease. Therefore, except pharmacotherapy, prevention and non-pharmacological cure have a big role in the process of OP treatment. By this is mostly meant of how to treat fracture, as the most severe consequence. For that purpose, various forms of physical therapy have been applied, as well as different rehabilitation modes aimed at pain lessening and enhancement of patients’ functional abilities. Various function-aids must be added to the aforementioned methods, which significantly ease the activities of everyday living