Učinkovitost i sigurnost tjelovježbe u idiopatskim upalnim miopatijama – prikaz bolesnika i pregled literature

Domagoj Andrić, Ružica Čunović-Dubroja, Darija Granec, Miroslav Mayer, Iva Milivojević, Lorena Petrač, Branimir Anić

Idiopatske upalne miopatije (engl. idiopathic inflammatory myopathies – IIM) su rijetke sustavne autoimunosne bolesti karakterizirane slabošću proksimalnih mišića, znakovima upale i oštećenja mišića i drugih organskih sustava, prvenstveno pluća. Rano prepoznavanje bolesti i pravovremeni početak liječenja smanjuju mišićnu upalu, trajna oštećenja mišića i razvoj ekstramuskularnih komplikacija. Temelj farmakološkog liječenja su glukokortikoidi uz dodatak imunosupresivnih i imunomodulirajućih lijekova. Klinički i serološki podtipovi miozitisa vrlo su različiti i ne reagiraju jednako na farmakološku terapiju. Terapijske su vježbe, uz medikamente, važan čimbenik u liječenju IIM-a. Povećanje mišićne snage, smanjenje onesposobljenosti, protuupalni učinci i poboljšanje metabolizma u mišićnim stanicama učinci su tjelovježbe dokazani u mnogim znanstvenim studijama. Vježbe su se pokazale sigurnima i učinkovitima u akutnoj i kroničnoj fazi miozitisa. Rehabilitacijski program vježbi treba individualno prilagoditi svakom bolesniku, a njegov učinak mjeriti validiranim instrumentima. U ovom radu prikazujemo trogodišnji klinički tijek bolesnika s anti-SRP pozitivnim miozitisom, s posebnim osvrtom na akutnu stacionarnu rehabilitaciju u aktivnoj fazi bolesti te donosimo pregled literature.

Idiopathic inflammatory myopathies (IIM) are rare systemic autoimmune diseases characterized by proximal muscle weakness, evidence of muscle inflammation and damage and other extramuscular organ involvement, especially lungs.Early diagnosis and initiation of treatment reduces muscle inflammation and lowers the chance of developing extramuscular disease and muscle damage. Glucocorticoids are the cornerstone of pharmacological treatment, they are used in combination with immunosuppressive and immunomodulatory medications. Clinical and serological subtypes of IIM are very diverse, and they respond differently to pharmacological treatment. Therapeutic exercise in addition to medicaments is an important adjunct for the treatment of IIM. Improvement in muscle strength, impairment reduction, anti-inflammatory activity and increased metabolism in muscle fibers are all proven effects of exercise in many scientific studies.Exercise is a safe and effective treatment in both chronic and acute stage of myositis. Rehabilitation program should be individually adapted to every patient, and validated instruments should be used to measure clinically important change.In this paper we present a 3-year clinical course of a patient diagnozed with an anti-SRP positive myositis with a special review of stationary rehabilitation in the acute stage of the disease. Review of the literature is presented in discussion.