Juvenil İdiyopatik Artrit ve Egzersiz

Yıl 2016, Cilt: 3 Sayı: 1, 1 - 13, 04.04.2016

Pınar Kısacık Edibe Ünal

Öz

Juvenil idiyopatik artritli çocuklarda artritler, ağrı, kas zayıflığı, kemik doku zayıflığı,
büyüme ve gelişimsel bozukluklar, fonksiyonel kayıplar ve inaktivte en önemli sorunlardır.
Ancak zaman içinde gelişen fiziksel aktivitenin yetersizliği yorgunluğa, kas zayıflığı ve
fonksiyon kaybına, kemik yıkımına ve motor kontrol bozukluklarına yol açtığı
belirtilmektedir. Fiziksel egzersiz ise tüm bu sorunları çözümlemede önemli role sahiptir.
Literatürdeki egzersiz protokolleri süre, frekans, hastalık süresi, yoğunluk, çevre,
kompozisyon özellikleri açısından çeşitlendirilmektedir. Tüm çalışmalarda egzersizin, eklem
şişliğinde, ağrı skorlarında, eklem hareket açıklığında, kas kuvvetinde, aerobik kapasite,
fonksiyonel yetenek ve yaşam kalitesinde iyileşmeye yol açtığı belirtilmektedir. Sonuç olarak,
juvenil idiyopatik artritli çocuklar çocuklar için optimal egzersiz tedavisi programı; aerobik ve
nöromusküler eğitimi içermelidir. Bunların yanı sıra, ağrıyı azaltmayı ve çocuğun aktif
katılımı ile biyopsikososyal modelleri hedef almalı, fonksiyonel ve gelişimsel destek
sağlanmalıdır. Çocuk, rekreasyonel ve sportif aktivitelere yönlendirilmeli, böylece egzersiz
planı yaşam planı haline getirilmelidir.

Anahtar Kelimeler

Juvenil idiyopatik artrit, egzersiz, hastalık yönetimi

Juvenile Idiopathic Arthritis and Exercise

Öz

Arthritis, pain, muscle weakness, bone tissue defficiency, growth and developmental
deficits, functional loss and inactivity are the most important problems in children with
juvenile idiopathic arthritis. However, it is stated that the growing physical inactivity over
time, leads fatigue, muscle weakness and dysfunction, bone resorbtion and motor control
deficiency. The physical exercise has an important role in solving all these problems . The
exercise protocols in literature diversified in terms of duration, frequency, time, intensity,
environment and type/composition. In all studies, it was reported that exercise improves joint
swelling, pain scores, range of motion, muscle strength , aerobic capacity, functional ability
and quality of life. In conclusion, the optimal exercise program for children with juvenile
idiopathic arthritis should be combined with aerobic and neuromuscular training. Besides that,
it should be aimed reducing pain and biopsychosocial models with active participation of
child, and provided functional and developmental support. The child should be encouraged to
participate in recreational and sports activities, so that exercise plan should be integrated in to
life plan.

Anahtar Kelimeler

Juvenile idiopathic arthritis, exercise. management of disease

Kaynakça

• Andersson Gare, B. (1999). Juvenile arthritis--who gets it, where and when? A review of current data on incidence and prevalence. Clin Exp Rheumatol, 17(3), 367-374.
• Baum, J. (1983). Treatment of juvenile arthritis. Am Fam Physician, 27(3), 133-139.
• Bekkering, W. P., ten Cate, R., van Suijlekom-Smit, L. W., Mul, D., van der Velde, E. A., & van den Ende, C. H. (2001). The relationship between impairments in joint function and disabilities in independent function in children with systemic juvenile idiopathic arthritis. J Rheumatol, 28(5), 1099-1105.
• Boros, C., & Whitehead, B. (2010). Juvenile idiopathic arthritis. Aust Fam Physician, 39(9), 630-636.
• Burnham, J. M., Shults, J., Sembhi, H., Zemel, B. S., & Leonard, M. B. (2006). The dysfunctional muscle-bone unit in juvenile idiopathic arthritis. J Musculoskelet Neuronal Interact, 6(4), 351-352.
• Cornil, M.V. (1864). Mémoire sur les coincidences pathologiques du rhumatisme articulaire chronique. C R Mém Soc Biol (Paris), 3, 3-25.
• E. D. Harris Jr, R. C. Budd, G. S. Firestein (2004). Kelley's Textbook of Rheumatology, (7th ed. Vol. 1): Elsevier Saunders,.
• Ekdahl, C., & Broman, G. (1992). Muscle strength, endurance, and aerobic capacity in rheumatoid arthritis: a comparative study with healthy subjects. Ann Rheum Dis, 51(1), 35-40.
• Epps, H., Ginnelly, L., Utley, M., Southwood, T., Gallivan, S., Sculpher, M., & Woo, P. (2005). Is hydrotherapy cost-effective? A randomised controlled trial of combined hydrotherapy programmes compared with physiotherapy land techniques in children with juvenile idiopathic arthritis. Health Technol Assess, 9(39), iii-iv, ix-x, 1-59.
• Fahrer, H., Rentsch, H. U., Gerber, N. J., Beyeler, C., Hess, C. W., & Grunig, B. (1988). Knee effusion and reflex inhibition of the quadriceps. A bar to effective retraining. J Bone Joint Surg Br, 70(4), 635-638.
• Galantino, M. L., Galbavy, R., & Quinn, L. (2008). Therapeutic effects of yoga for children: a systematic review of the literature. Pediatr Phys Ther, 20(1), 66-80. doi: 10.1097/PEP.0b013e31815f1208
• Garrod, AB. . (1876). A Treatise on Gout and Rheumatic Gout. . London
• Henderson, C. J., Lovell, D. J., Specker, B. L., & Campaigne, B. N. (1995). Physical activity in children with juvenile rheumatoid arthritis: quantification and evaluation. Arthritis Care Res, 8(2), 114-119.
• Kisacik, P., Unal, E., Akman, U., Yapali, G., Karabulut, E., & Akdogan, A. (2016). Investigating the effects of a multidimensional exercise program on symptoms and antiinflammatory status in female patients with ankylosing spondylitis. Complement Ther Clin Pract, 22, 38-43. doi: 10.1016/j.ctcp.2015.11.002
• Klepper, S. E. (2003). Exercise and fitness in children with arthritis: evidence of benefits for exercise and physical activity. Arthritis Rheum, 49(3), 435-443. doi: 10.1002/art.11055
• Klepper, S. E. (2008). Exercise in pediatric rheumatic diseases. Curr Opin Rheumatol, 20(5), 619-624. doi: 10.1097/BOR.0b013e32830634ee
• Lee, M. S., Pittler, M. H., & Ernst, E. (2007). Tai chi for rheumatoid arthritis: systematic review. Rheumatology (Oxford), 46(11), 1648-1651. doi: 10.1093/rheumatology/kem151
• Lelieveld, O. T., Armbrust, W., van Leeuwen, M. A., Duppen, N., Geertzen, J. H., Sauer, P. J., & van Weert, E. (2008). Physical activity in adolescents with juvenile idiopathic arthritis. Arthritis Rheum, 59(10), 1379-1384. doi: 10.1002/art.24102
• M. C. Hochberg, A. J. Silman, J. S. Smolen, M. E. Weinblatt, M. H. Weisman. (2008). Rheumatology (4th ed.): Mosby-Elsevier.
• MacRae, V. E., Farquharson, C., & Ahmed, S. F. (2006). The pathophysiology of the growth plate in juvenile idiopathic arthritis. Rheumatology (Oxford), 45(1), 11-19. doi: 10.1093/rheumatology/kei091
• Mendonca, T. M., Terreri, M. T., Silva, C. H., Neto, M. B., Pinto, R. M., Natour, J., & Len, C. A. (2013). Effects of Pilates exercises on health-related quality of life in individuals with juvenile idiopathic arthritis. Arch Phys Med Rehabil, 94(11), 2093-2102. doi: 10.1016/j.apmr.2013.05.026
• Metin, G., Ozturk, L., Kasapcopur, O., Apelyan, M., & Arisoy, N. (2004). Cardiopulmonary exercise testing in juvenile idiopathic arthritis. J Rheumatol, 31(9), 1834-1839.
• Myer, G. D., Brunner, H. I., Melson, P. G., Paterno, M. V., Ford, K. R., & Hewett, T. E. (2005). Specialized neuromuscular training to improve neuromuscular function and biomechanics in a patient with quiescent juvenile rheumatoid arthritis. Phys Ther, 85(8), 791-802.
• Ozen, S., Karaaslan, Y., Ozdemir, O., Saatci, U., Bakkaloglu, A., Koroglu, E., & Tezcan, S. (1998). Prevalence of juvenile chronic arthritis and familial Mediterranean fever in Turkey: a field study. J Rheumatol, 25(12), 2445-2449.
• Paap, E., van der Net, J., Helders, P. J., & Takken, T. (2005). Physiologic response of the six-minute walk test in children with juvenile idiopathic arthritis. Arthritis Rheum, 53(3), 351-356. doi: 10.1002/art.21175
• Packham, J. C., & Hall, M. A. (2002). Long-term follow-up of 246 adults with juvenile idiopathic arthritis: functional outcome. Rheumatology (Oxford), 41(12), 1428-1435.
• Roth, J., Linge, M., Tzaribachev, N., Schweizer, R., & Kuemmerle-Deschner, J. (2007). Musculoskeletal abnormalities in juvenile idiopathic arthritis--a 4-year longitudinal study. Rheumatology (Oxford), 46(7), 1180-1184. doi: 10.1093/rheumatology/kem100
• Roth, J., Palm, C., Scheunemann, I., Ranke, M. B., Schweizer, R., & Dannecker, G. E. (2004). Musculoskeletal abnormalities of the forearm in patients with juvenile idiopathic arthritis relate mainly to bone geometry. Arthritis Rheum, 50(4), 1277-1285. doi: 10.1002/art.20128
• Schaller, J. G. (1997). Juvenile rheumatoid arthritis. Pediatr Rev, 18(10), 337-349.
• Singh-Grewal, D., Schneiderman-Walker, J., Wright, V., Bar-Or, O., Beyene, J., Selvadurai, H., Feldman, B. M. (2007). The effects of vigorous exercise training on physical function in children with arthritis: a randomized, controlled, single-blinded trial. Arthritis Rheum, 57(7), 1202-1210. doi: 10.1002/art.23008
• Singh-Grewal, D., Wright, V., Bar-Or, O., & Feldman, B. M. (2006). Pilot study of fitness training and exercise testing in polyarticular childhood arthritis. Arthritis Rheum, 55(3), 364-372. doi: 10.1002/art.21996
• Southwood, T. R. (1995). ABC of rheumatology. Arthritis in children. BMJ, 310(6981), 728-732.
• Takken, T., Hemel, A., van der Net, J., & Helders, P. J. (2002). Aerobic fitness in children with juvenile idiopathic arthritis: a systematic review. J Rheumatol, 29(12), 2643-2647.
• Takken, T., Van Der Net, J., Kuis, W., & Helders, P. J. (2003). Aquatic fitness training for children with juvenile idiopathic arthritis. Rheumatology (Oxford), 42(11), 1408-1414. doi: 10.1093/rheumatology/keg386
• Unal, E. (2014). Romatizmal Hastalıkalrda Biyopsikososyal Model: Bilişsel Egzersiz Terapi Yaklaşımı (BETY) (1 ed.). Ankara: Pelikan Yayıncılık.
• van Brussel, M., Lelieveld, O. T., van der Net, J., Engelbert, R. H., Helders, P. J., & Takken, T. (2007). Aerobic and anaerobic exercise capacity in children with juvenile idiopathic arthritis. Arthritis Rheum, 57(6), 891-897. doi: 10.1002/art.22893
• van der Net, J., van der Torre, P., Engelbert, R. H., Engelen, V., van Zon, F., Takken, T., & Helders, P. J. (2008). Motor performance and functional ability in preschool- and early school-aged children with Juvenile Idiopathic Arthritis: a cross-sectional study. Pediatr Rheumatol Online J, 6, 2. doi: 10.1186/1546-0096-6-2
• Wedderburn, Ross E Petty & Ronald Laxer & Carol Lindsley & Lucy. (1995). Textbook of Pediatric Rheumatology (7th ed.): Elsevier.