リウマトイド関節炎の早期の対策

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As early therapeutic measures for rheumatoid arthritis(RA), physical therapy and occupational therapy have been provided during the past 20 years at the outpatient clinic. Based on this experience, the author engaged in therapy of RA has consistently stressed the importance of early detection of impairment and for this purpose daily activity checklist(Shiino, 1996)has proven to be useful. Nonetheless, the level of recognition of rehabilitation medicine for RA is low. The cause involved not only lies on the part of physicians engaged in the treatment of RA but also on the part of physical therapists and occupational therapists who have not received adequate education on RA. The author in order to overcome this situation established the Japanese Society for Rehabilitation Medicine of Rheumatoid Arthritis 15 years ago and activities have been continued for enlightenment. As early practical measure, it is first necessary to study the psychology of RA patients. This is because it is necessary to properly ascertain arthralgia, as there is no adequate scale available to evaluate pain. Next for evaluation of functional disorder, though ROM-T, MMT, and ADL-T are available at present, the objectivity of these tests cannot be said to be sufficient. Study must be made in the future on the management system for precision of various medical facilities. To increase muscle power, heavy load at lower frequency is more effective in therapy. However, for this purpose voluntary training must be made at home. The next problem is that a standard is not available for practical evaluation of therapeutic effect. In order to evaluate improvement of ROM, a method is presented to indicate that value of more than 10° after therapy. In increasing muscle power, as MMT itself is a subjective evaluation, a suitable method is still being studied. Lastly, it is important that adequate study of routine medical care should be made to carefully evaluate the therapeutic results before and after therapy and for cases not demonstrating any therapeutic effect, medical therapy should not be aimlessly continued. When DRG/PPS is introduced in the future, there is a possibility that physical therapy and occupational therapy may be amalgamated. Rather than treating an established impairment, it is important that treatment should be made of impairment at the reversible stage.
社団法人日本リハビリテーション医学会の論文
2001-10-18

リウマトイド関節炎の早期の対策

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