bfkt_artropatiepsoriazica_varianta basic_ancuta.pptx
TRANSCRIPT
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RECUPERARE IN REUMATOLOGIE
ARTROPATIA PSORIAZICA (APSO)
CODRINA ANCUTAMD, PhD, sef lucrari
REUMATOLOGIE & RECUPERAREUMF Gr. T. Popa Iasi
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Plan de lucru Definitie Tablou clinic Deficite functionale caracteristice Evaluare (clinica, biologica,
imagistica) Tratament medicamentos si
recuperator
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SPONDILARTRITE Grup de boli ce au in comun caracteristici
etiopatogenice, genetice, clinice &
radiologice
• afectare axiala (vertebral & sacroiliita) • inflamatie osificare• afectare articulara
periferica (membre inferioare)• entezite & dactilite• manifestari extra-
articulare (ocular, digestiv, genito-urinar, cutanat )• asocierea HLA-B27+• barbat tanar (26 ani)
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Artropatia psoriazica (APSo)
•artropatie inflamatorie asociata psoriazisului (cutanat si/sau unghial)
•artropatie seronegativa & fara noduli reumatoizi
•5% Pso dezvolta afectectare articulara
Defini-tie
•prevalenta Pso = 2-3% ; APso = 1%•debut 20-40 ani (rar Apso juvenila 9-12
ani)•rasa alba
Date epidemiologice
•distributie egala pe sexe•particularitati in functie de forma
clinica•forma axiala – barbat; forma
poliarticulara – femeie
Particu-
laritati
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Tablou clinic
cutanat articular•
succesiune 75%
•coincidenta 15%•
inversiune 10%
debut insidios, mono-/oligo-/poliarticular• durere inflamatorie • redoare matinala (> 30 min)• tumefiere articulara
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Manifestari musculo-scheletale
Articulare • oligoartrita asimetrica:
articulatii (mici & mari) + dactilita + leziuni cutanate minime
• poliartrita simetrica: pattern PR-like, cu interesarea interfalangiene distale
• afectare izolata interfalangiene distaIe: + onicopatie psoriazica
• artrita mutilanta• forma axiala – pattern SA-
like
Alte manifestari
• Dactilita• Entezita• Tenosinovite
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ACR website
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• VSH• CRP
Sdr inflamator
• Rg maini & antepicior
• Distructie & formare osoasa
• Rg bazin pt sacroiliace
• Unilateral/bilateral asimetrica
• Rg coloana• parasindesmofite
Examen imagistic
Explorare paraclinica
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TERAPIA MEDICAMEN-
TOASA
BOALA CUTANATA
Obiective specifice
leziunea cutanata & unghiala & dactilita
Obiective clasice- reducere durere & inflamatie - incetinire/ stopare progresiei Rg- ameliorare functionala
BOALA ARTICULAR
A
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Tratament recuperator
APso = afectiune sistemica inflamatorie, distructiva &
productive, progresiva program de recuperare complex, individualizat,
monitorizat, initiat precoceObiective: Promovarea independentei
functionale in activitatea cotidiana Protectia articulatiilor afectate
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Programe de recuperare Electroterapie (curenti joasa, medie
freecventa), ultrasonoterapie, laserterapie
Termoterapie (cald, rece) KT (posturare, repaus - local si
sistemic, exercitii - pasive, active, stretching, enduranta)
Terapie ocupationala Ortezare (articulatii periferice,
vertebrala), pt mers Tehnici de protectie articulara
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Puseu de activitate boala
Repaus Splint-uri (mana, genunchi, tibio-
tarsiene) pt repaus, ameliorare durere
Termoterapie – rece (scaderea inflamatiei, ameliorare durere)
KT: posturare, exercitii pasive, exercitii de protectie articulara
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Etapa de cronicitate
Exercitii izometrice Cresterea graduala a amplitudinii de
miscare pornind de la exercitii pasive exercitii active
Stretching gradat, progresiv; persistenta durerii > 2 ore postterapie impune reducerea intensitatii exercitiului fizic
Exercitiile cu rezistenta se contraindica in conditii de persistenta a tumefactiei articulare
Afectarea axiala - exercitii de mentinere a flexibilitatii si tonifiere musculara
dactilita, fasciita plantara: terapie protectiva
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Terapia ocupationala Evaluare ergonomica – benefica pt
modificarea mediului de lucru pt evitarea pensionarii precoces