Rheumatoid arthritis is a systemic autoimmune disease in which the joints are preferentially attacked. 2019 Aug;33(4):101440. doi:10.1016/j.berh.2019.101440, Lipina M, Makarov M, Mukhanov V, Karpashevich A, Maglevaniy S, Amirdjапоvа V, Archipov S. Arthroscopic synovectomy of the knee joint for rheumatoid arthritis. Damage to the joint tissues, in particular to joint cartilage, develops slowly and to relatively severe stages before joint pain becomes noticeable. ; Joint damage can occur early and does not always correlate with the severity of RA … 12 repetitions), Between 3 and 4 on modified 10 pt Borg Scale, directly activate endothelial cells via increased production of VCAM1, which increases the adhesion and accumulation of inflammatory cells, producing RANKL which in turn activate osteoclasts causing subchondral. Verywell Health's content is for informational and educational purposes only. Many patients with other autoimmune disorders and inflammatory conditions test positive for rheumatoid factor but don’t have rheumatoid arthritis. Updated March 2019, Jacob H, Curtis AM, Kearney CJ. Prominent degenerative change is also seen at the ulnar-carpal articulation. May be swelling, stiffness, deformity, and tenderness of the PIP, MCP wrist, knee joints, referred to as synovitis, and there may be a decreased range of motion. Coaching patients with early rheumatoid arthritis to healthy physical activity: a multicenter, randomized, controlled study. ; Joint damage can occur early and does not always correlate with the severity of RA … (level 5), Pelland L, Brosseau L, Casimiro L, Robinson VA, Tugwell P, Wells G. Electrical stimulation for the treatment of rheumatoid arthritis. Symptoms generally include joint pain and stiffness. Dosages, Precautions, Everything to Know About Rheumatoid Arthritis and COVID-19, Recommended Diet for Rheumatoid Arthritis, How Rheumatoid Arthritis Affects Mental Health, Everything to Know About How Rheumatoid Arthritis Affects the Eyes, Understanding the Cycle of Pain in Rheumatoid Arthritis, Everything to Know About Hypothyroidism and Rheumatoid Arthritis. 5th edition. The pharmacist should educate the patient on types of drugs used to treat rheumatoid arthritis and their potential side effects. This advancing condition is characterized by more frequent bouts of inflammation and worsening chronic pain. Disease vs. Found inside – Page 178Rheumatoid Arthritis Kienböck's Disease Radiograph of wrist shows characteristic DEGENERATIVE/ARTHRITIC CONDITIONS ... Hx: Prior trauma/fall (often untreated), pain PE: +/J decreased ROM with pain, tenderness to palpation XR: 4 stages. MRI and US are more sensitive than clinical examination in identifying synovitis and joint effusion.[1]. There are four stages. This protein aids the body’s immune system function, and it is released in response to inflammation.1 A normal CRP level should be lower than 10 milligrams per liter (mg/L). There is no laboratory test that is pathognomonic for rheumatoid arthritis. The disease commonly affects the hands, knees or ankles, and usually the same joint on both sides of the body, such as both hands or both knees. Best Pract Res Clin Rheumatol. Rheumatoid arthritis is a condition characterized by joint inflammation. Updated July 27, 2020. Inflammatory markers, including erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), may be elevated in the blood. This is the severe stage. (Level1), Jong Z de, Munneke M, Zwinderman AH, Kroon HM, Jansen A, Ronday KH, et al. Rheumatoid arthritis (RA) symptoms are different for each person who has this long-term disease.. Houten: Bohn Stafleu van Loghum 2004. The immunoregulatory role of myeloid-derived suppressor cells in the pathogenesis of rheumatoid arthritis. Early signs include fatigue, fever, … Preference is given to an active policy, especially where the physiotherapist has a supporting role. The doctor will say you’ve lost range of motion. Updated March 2019. The physical exam shows joint tenderness and swelling. Rheumatoid arthritis (RA) is a chronic systemic inflammatory disease of unknown cause. It is a chronic disorder that increases in prevalence with advancing age, but it … The three most important complaints are the pain, morning stiffness and fatigue. Front Immunol. When this … (Level 1B), Bijlsma J.W.J., Geusens P.P.M.M., Kallenberg C.G.M., P.P. Arthritis Rheum. Rheumatoid arthritis (RA) is a chronic systemic inflammatory disease of unknown cause. Is a long term high intensity exercise program effective and safe in patients with rheumatoid arthritis? Other symptoms may include redness, warmth, swelling, and decreased range of motion of the affected joints. Physiotherapy help clients cope with chronic pain and disability through the design of programs that address flexibility, endurance, aerobic condition, a range of motion (ROM), strength, bone integrity, coordination, balance and risk of falls. It commonly affects the joints of the hands, fingers, feet, and knees. Read our, Verywell Health uses cookies to provide you with a great user experience and for our, How Rheumatoid Arthritis Affects Each Part of the Body, Skin Problems Associated With Rheumatoid Arthritis, Rheumatoid Arthritis and Your Gastrointestinal Tract: What You Need To Know. Rheumatoid arthritis (RA) is a chronic condition for which there is no cure. Davis Company. Found inside – Page 172metalloproteinases and cytokines in the microenvironment,4,69 Thus, a dysfunctional vascular network leads to disruption ... synovial specific T- cell clone may be associated with the early stages of RA, underlining the importance of T ... All individuals have multiple exacerbations and remissions. Many patients with other autoimmune disorders and inflammatory conditions test positive for rheumatoid factor but don’t have rheumatoid arthritis. But it’s more likely if you have low or good scores on these RA assessments when you’re diagnosed: Your RA doctor can check to see how your disease has changed. The overall prevalence is 0.5-1% and the disease is 2-3 times more common in women. Ⓒ 2021 About, Inc. (Dotdash) — All rights reserved, Anti-cyclic Citrullinated Peptide (Anti-CCP), Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Image 4: Advanced features of rheumatoid arthritis, with erosive subluxation most marked of the MCP joints with ulnar deviation. The earliest signs and symptoms can be mimicked by other conditions, but because they often appear together, they are considered specific characteristics of the condition. Exercise for rheumatoid arthritis of the hand. Found inside – Page 158Describe the typical radiographic presentation of rheumatoid arthritis . There are four distinct stages : stage 1 , normal radiograph with the possibility of osteoporosis and active synovitis ; stage 2 , symmetric joint narrowing and ... Everybody's different when it comes to rheumatoid arthritis (RA). Symptoms generally include joint pain and stiffness. Cochrane Database Syst Rev 2000;(2):CD000322. • Formulate achievable goals with the patient. 2020 Sep 15;11:568362. doi: 10.3389/fimmu.2020.568362. So what now? Treat Your Own Knee Arthritis takes a new approach to an old problem. Surgery is a last-resort treatment for very severe RA. The benefits of physical therapy interventions have been well documented. Learn more about the stages of rheumatoid arthritis, along with treatment options. Progressive Rheumatoid Arthritis. Pain and stiffness often worsen following rest. There may not be as much redness or swelling as there is in later stages. Are Rheumatoid Arthritis Patients More Susceptible to Periodontal Disease? Found inside – Page 660Rheumatoid Arthritis Definition Rheumatoid arthritis (RA) is a chronic systemic disease that involves articular inflammation ... F. Positive rheumatoid factor test G. Radiographic changes consistent with RA There are four stages of RA. Pain and stiffness often worsen following rest. RA with symptom duration of fewer than six months is defined as early, and when the symptoms have been present for more than months, it is defined as established. Physical therapists play an integral role in the nonpharmacologic management of RA. Some patients may present with monoarticular joint involvement. Mayo Clinic: “C-reactive protein test.”Breedveld, F., Annals of the Rheumatic Diseases, January 2005. Learn more about the stages of rheumatoid arthritis, along with treatment options. • The therapist has to involve the partner and other important people in the process because they have an important motivation-role. Polyarthritis of small joints of hands: proximal interphalangeal (PIP), metacarpophalangeal (MCP) joints and wrist. In acute phase: isometric/static exercises -> be held for 6 seconds and repeated 5–10 times each day ; load = 40% 1RM. Usually happen after eg experiencing a secondary illness, being involved in a high stress situation, overexerting oneself, What triggers flare ups is currently still unknown. What are the first signs of rheumatoid arthritis? What Is Rheumatoid Arthritis of the Knee? Side effects from treatment and medication. Rheumatoid nodules may be present in 20% of patients with rheumatoid arthritis; these occur over extensor surfaces at elbows, heals, and toes. Pain and stiffness often worsen following rest. Found insideSympRheumatoid Arthritis toms intensify , and drug therapy must Osteoarthritis In rheumatoid arthritis ... This auto- In stage 4. the disease process extends or simply the " wear - and - lcar " disease , immune response is a chain ... Dietary modification include: Rheumatoid arthritis is a chronic disorder that has no cure. Arthritis Rheum. Gout, the most common type of inflammatory arthritis, develops in some people who have high levels of uric acid from the breakdown of purines, which are found in human cells and many foods, including red meat, organ meats and some seafoods. Rheumatoid arthritis progresses for different people in different ways. Rheumatoid arthritis (RA) should be suspected in the adult patient who presents with inflammatory polyarthritis. 2008 Oct;121(10 Suppl 1):S9-14. In RA, multiple joints are usually, but not always, affected (polyarthritis) in a symmetrical pattern. All the currently available treatments are geared towards improving the symptoms and offering a better quality of life. Stage 1: In the early stages, your joint lining, or synovium, becomes inflamed. Rheumatoid arthritis (RA) is a systemic autoimmune disease characterized by inflammatory arthritis and extra-articular involvement. But living with it doesn’t have to mean sitting on the sidelines. This book offers the same expert knowledge that Mayo Clinic doctors, nurses and therapists use in caring for patients. Found inside – Page 7061Khirurgiia ( Sofiia ) 1985 ; 38 ( 5 ) : 72-4 stages in the recovery of work capacity in patients who ( Eng ... of an urban ECONOMICS ( Dispensary care of rheumatoid arthritis patients ) Trofimova polyclinic ) Krasnova MN , et al . PUBLISHED 11/14/18 BY Tina Donvito Here’s why the disease progresses, what to expect, and how to stop it. Rheumatoid arthritis (RA) causes joint inflammation and pain. infliximab), tocilizumab, abatacept, rituxumab, targeted synthetic DMARDs (tsDMARDs): e.g. It happens when the immune system doesn’t work properly and attacks the lining of the joints, called the synovium. RA is considered a systemic disease because it can also involve more than just joints—potentially damaging skin, blood vessels, lungs, eyes, and/or the heart.. Numerous tables, graphs, and figures add further clarity to the text." ...Written by experts in the field, this book is updated with the latest advances in pathophysiology and treatment. Strategies that can help someone who is experiencing a flare up. Arthritis is when there is wear and tear in the bones and cartilage, which can affect any of the knee bones. Each has its own treatment options. There are four stages. Found inside – Page 390... (4, 5), their role in the pathogenesis of juvenile rheumatoid arthritis is unknown. Our aim was to test the presence of immune complexes in the sera of patients with distinct types of onset and in different stages of the disease. It commonly affects the joints of the hands, fingers, feet, and knees. This is when you may have trouble with regular daily activities because of pain. Dietary interventions demonstrate substantial benefits in reducing disease symptoms such as pain, joint stiffness, swelling, tenderness and associated disability with disease progression (still an uncertainty about the therapeutic benefits of dietary manipulations for RA)[9]. This advancing condition is characterized by more frequent bouts of inflammation and worsening chronic pain. Prescription disease-modifying agents are a cornerstone of RA treatment, and exercise is central to osteoarthritis treatment. Other early signs of rheumatoid arthritis may include joint stiffness that lasts at least 30 minutes, especially in the mornings. In some types of arthritis, other organs are also affected. Clin Rheumatol. Psoriatic arthritis is a type of psoriasis characterized by inflammation that affects the skin and the joints. We examine early stage RA symptoms in the hands, and disease progression. Rheumatoid arthritis is a chronic (long-term) disease that can cause pain and swelling in your joints. Found inside – Page 469What are the 4 stages of rheumatoid arthritis ? 1. Acute inflammatory reaction 2. Hyperplasia and hypertrophy of synovial lining cells 3. Pannus ( granulation tissue ) extension 4. Fibrosis , contracture , and deformity from destruction ... 2004; 6(2): 3. Am J Med. Other features may include the presence of carpal tunnel syndrome, tenosynovitis and finger deformities. It typically results in warm, swollen, and painful joints. It is a chronic disorder that increases in prevalence with advancing age, but it can begin at any age. Symptoms include pain, swelling, and stiffness of the joints. Comparison of the analytical and clinical performances of four anti-cyclic citrullinated peptide antibody assays for diagnosing rheumatoid arthritis. Moderate stage. • Enough variation in the exercises is important to prevent boredom. Conditioning exercises in people with chronic inactive RA: swimming walking, cycling (include adequate rest periods). It typically results in warm, swollen, and painful joints. This surgery may be done to relieve symptoms of RA or other types of joint inflammation when medication is ineffective. The key is patient education by nurses, pharmacists, and primary care providers. Written by three authorities in the field, and including more than 600 images, this compendium helps professionals understand the recent advances in the use of magnetic resonance imaging and ultrasound for the diagnosis and treatment of ... Each has its own treatment options. Gabriel SE. 2008;59;3:325-31. 2019 Aug;43(8):1859-1863. doi:10.1007/s00264-018-4160-z, Amini A, Yahyanezhad S, Velez E, Gholamrezanezhad A, Fotoohi M, Jafari E, Assadi M. Prospective evaluation of phosphorus-32 radiation synovectomy in patients with severe and chronic rheumatoid arthritis unresponsive to conventional medical treatment. Rheumatoid factor is an autoantibody. The drugs used to treat rheumatoid arthritis also have potent side effects which often are not well tolerated. Rheumatoid Arthritis Disease Activity Index (RADAI-5): A self-reported. Int Orthop. You might start to notice deformities as the bones move around. Prescription treatments include anti-inflammatory medications, disease-modifying anti-rheumatic drugs (DMARDs), Janus kinase (JAK) inhibitors. Physiopedia articles are best used to find the original sources of information (see the references list at the bottom of the article). The earliest signs and symptoms can be mimicked by other conditions, but because they often appear together, they are considered specific characteristics of the condition. Centers for Disease Control and Prevention. TNF-α inhibitors (e.g. Found inside – Page 448The damage is reversible until cartilage and bones become involved (stages 4 and 5). At that time the changes become irreversible and result in severe functional impairment. The most common clinical presentation of rheumatoid arthritis ... Rheumatoid arthritis. I give my consent to Physiopedia to be in touch with me via email using the information I have provided in this form for the purpose of news, updates and marketing. The duration and intensity of the exercises should be based on the individual patient and their assessment, When the patient experiences an exacerbation and the joints are acutely inflamed then isometric exercises should be done, Revise the exercise program if pain persists 2 hours after the activity or there is an increase in joint swelling, Patients with active RA in their knees should avoid climbing stairs or weight lifting as it could lead to intra-articular pressure in the knee joint, Avoid excessive stress over the tendons with stretches and avoid ballistic movements. Examine the joints on swelling, pain due to palpation, pain due to movement, decreased range of motion, deformation and instability. Early stage. It happens when the immune system doesn’t work properly and attacks the lining of the joints, called the synovium. The joint will be stiff, and you won’t be able to move it as far as you used to. 2020 Jun 5. Patients with rheumatoid arthritis have 2-3 times higher risk of death compared to the general population. Rheumatoid arthritis (RA) is a systemic autoimmune disease characterized by inflammatory arthritis and extra-articular involvement. The bones aren’t damaged yet. Increases risk: Female sex; occupational dust (silica); air pollution; high sodium red and iron consumption; low vitamin D intake and levels; Deceased risk: fish and omega 3 fatty acid consumption; moderate alcohol intake; healthy diet; oral contraceptive/HRT; statin use. Rheumatoid papules are skin lesions that can appear with rheumatoid arthritis. Patient Education: information about their condition and the different therapies disposed to improve their quality of life. Rheumatoid arthritis (RA) is a systemic autoimmune disease characterized by inflammatory arthritis and extra-articular involvement. • Give proper instructions and be sure that the patient understands. Harris, E., Kelley's Textbook of Rheumatology, 7th edition, W.B. Your ESR would be interpreted based on standards calibrated in the lab where your test is being done. Found insideDiagnosis is confirmed with the presence of four of the seven criteria for RA developed by the American College of ... Table 18-1 Stages of Rheumatoid Arthritis Stage Description Symptoms 1 Stage I (Mild) RA: Initial onset of symptoms. It typically starts in small peripheral joints, is often symmetric, and progresses to involve proximal joints if left untreated. Infections, chronic inflammation, cancer, and heart or kidney disease are among the causes of high ESR. Patellofemoral Arthritis. Do Herbal Remedies for Rheumatoid Arthritis Help? Rheumatoid arthritis (RA) is an autoimmune disease that mainly attacks the synovial tissues around the joints. In RA, multiple joints are usually, but not always, affected (polyarthritis) in a symmetrical pattern. Plaques are thick, scaly skin lesions. Williams MA, Srikesavan C, Heine PJ, Bruce J, Brosseau L, Hoxey‐Thomas N, Lamb SE. There are several options. Chronic inflammation occurs when immune cells and proteins are persistently elevated, and it can affect the whole body or may target a specific location (or locations). Onset can be gradual or sudden. The hallmark feature of this condition is persistent symmetric polyarthritis (synovitis) that affects the hands and feet, though any joint lined by a synovial membrane may be involved. Rheumatoid arthritis can affect people of any age including very young children and it is a condition where the immune system which usually protects us from infections, starts to attack the joints causing pain, stiffness and swelling. It will gradually erode bare areas initially, followed by the articular cartilage. Most commonly, the wrist and hands are involved, with the same joints typically involved on both sides of the body. DAS-Crp (disease activity score): tender joint count, swollen joint count, patient global assessment, and c reactive protein in mg/dl. Rheumatoid arthritis (RA). ; Joint damage can occur early and does not always correlate with the severity of RA … Cold/Hot Applications: cold for acute phase; heat for chronic phase and used before exercise. It typically starts in small peripheral joints, is often symmetric, and progresses to involve proximal joints if left untreated. Gout, the most common type of inflammatory arthritis, develops in some people who have high levels of uric acid from the breakdown of purines, which are found in human cells and many foods, including red meat, organ meats and some seafoods. These effects are produced by immune cells that mistakenly attack joints, and sometimes other organs of the body as well. Rheumatoid arthritis (RA) is an autoimmune disease in which the body’s immune system attacks its own tissue. In: StatPearls [Internet]. Exclusive breastfeeding delays the return of the mother’s menstrual period, which can help extend the time between pregnancies. It is characterized by inflammation and tissue damage that is caused by the body’s own immune system working against itself. The earliest signs and symptoms can be mimicked by other conditions, but because they often appear together, they are considered specific characteristics of the condition. Managing Rheumatoid Arthritis with Dietary Interventions. It is a chronic disorder that increases in prevalence with advancing age, but it … 2003;48;9:2415-24. Certain inherited abnormalities in the genes that direct the immune system have been identified in association with RA. tofacitinib. That includes when your joints are deformed and damaged and limit your mobility. Progress to a high-intensive exercise program if possible aimed at improving aerobic capacity, strength and endurance. Rheumatoid factor is a type of antibody found in the majority of RA patients. Damage to the lung tissue (rheumatoid lung) See. Treatment of rheumatoid arthritis is aimed at improving the symptoms and slowing disease progression. Reumatoïde artritis. Some of the diverse topics covered in this book address the varied aspects that fall under the diagnosis and treatment of rheumatoid arthritis. It will serve as a reference to a broad spectrum of readers. Late in the course of the disease patient may present with "boutonniere (flexion at PIP and extension at DIP), swan neck (flexion at DIP and extension at PIP) deformities, subluxation of MCP joints and ulnar deviation. Rheumatoid arthritis (RA) is an autoimmune disease in which the body’s immune system attacks its own tissue. 2020 Sep 23. doi: 10.1007/s10067-020-05412-w, American College of Rheumatology. Which Homeopathic Remedies Work for Rheumatoid Arthritis? Deformity, pain, weakness and restricted mobility resulting in loss of function. The Cochrane database of Systematic Reviews. And genetic changes tend to be more commonly identified among people who develop RA at a young age., RA diagnosis relies on a combination of symptoms, clinical exam, and diagnostic tests. Other commonly affected joints include wrist, elbows, shoulders, hips, knees, ankles and metatarsophalangeal (MTP) joints. Rheumatoid arthritis (RA) causes joint inflammation and pain. They don’t cause each other, but osteoarthritis and RA can coexist. If a patient tests positive for rheumatoid factor it helps to reach a diagnosis, but its presence doesn’t confirm it. A synovectomy is a type of operation in which the synovium (thin, fluid-filled lining inside the joints) is surgically removed due to severe inflammation. Stages of Rheumatoid Arthritis. How to Find a Rheumatoid Arthritis Support Group, What to Know About Biologics for Rheumatoid Arthritis (RA). X-ray of both hands and feet are usually obtained for the presence of erosions, the pathognomonic feature of rheumatoid arthritis (plain radiograph does not show early changes of the disease). They can itch or they might not produce any discomfort. Our website is not intended to be a substitute for professional medical advice, diagnosis, or treatment. American College of Rheumatology. Avoiding food which causes inflammation like processed food, high salt, oils, butter, sugar, and animal products. (Samenbundeling van zowel RCT’s, cohortstudies als case-control studies dus level of evidence: 1, 2 en 3), Verhagen AP, Bierma-Zeinstra SM, Cardoso JR, Bie RA de, Boers M, Vet HC de. Results of a randomized controlled trial. It is a chronic disorder that increases in prevalence with advancing age, but it … What You Should Know About CBD and Methotrexate, Symptoms of Rheumatoid Arthritis in Hands, Rheumatoid Arthritis and the Influence of Changing Seasons, How Lifestyle Choices Impact Rheumatoid Arthritis, Minocycline: Uses, Side Effects. Found inside – Page 370A hypogonadic status characterized by low-serum testosterone levels has been identified in male patients with rheumatoid arthritis, particularly during the active stages of the disease. Preliminary studies suggested a possible role for ... 2003;4:CD00518. Besides the joint disease, the individuals can suffer from many extra joint related problems which significantly alters the. In most cases Physiopedia articles are a secondary source and so should not be used as references. 1989;32;11:1396-1405. Goes on to causes fibrous ankylosis which eventually ossifies. Both conditions involve joint pain, and degeneration. The initial evaluation of such patients requires a careful history and physical examination, along with selected laboratory testing to identify features that are characteristic of RA or that suggest an alternative diagnosis. Dynamic exercise therapy for rheumatoid arthritis. The effects of chronic inflammation include swelling, tissue damage, fever, and fatigue., A C-reactive protein (CRP) blood test measures CRP, a protein that is produced by the liver and released into the blood. The three most common surgeries for RA are: How can you tell your RA is getting worse? Normally, anti-CCP should be less than 20 units per milliliter (u/mL), although different test kits or labs may have their own normal standards. However, the presence of rheumatoid factor is not diagnostic of rheumatoid arthritis. As the disease progresses, many patients will develop adverse cardiac events leading to death. Found inside – Page 85I. Böröcz and M. Szendrői 3.1 Rheumatoid Arthritis, Early and Late Stage Rheumatoid arthritis (RA) is a chronic, ... (3) arthritis of hand joints (lasting for more than 6 weeks), (4) symmetrical arthritis lasting for more than 6 weeks, ... Rheumatoid arthritis (RA) is a systemic autoimmune disease characterized by inflammatory arthritis and extra-articular involvement. An occupational therapy consult can help the patient manage daily living activities. Rheumatoid arthritis (RA) is a systemic autoimmune disease characterized by inflammatory arthritis and extra-articular involvement. The organizers wish to record their thanks to all the participants and delegates who made this such an enjoyable meeting. Our thanks are due to a number of members of the pharmaceutical industry who so kindly donated funds. Found inside – Page 334... patients with rheumatoid arthritis (RA). diagnosis total number rule 1 rule 2 of patients (ARA 1958 definite) (ARA 1987 definite) suspected RA 4 1 1 seropositive RA, stage 1 9 7 6 seronegative RA, stage 1 19 10 10 seropositive RA, ... A disease-modifying antirheumatic drug (DMARD), such as, Flares that are intense or last a long time, Diagnosis at a young age, which means the disease has more time to become active in your body, Active inflammation that shows up in tests of joint fluid or blood. The exercise program consists of the usual care plus a hand and wrist exercise program which includes seven mobility exercises and four strength exercises against resistance (i.e. Is an oedematous thickened hyperplastic synovium infiltrated by lymphocytes T and B, plasmocytes, macrophages, and osteoclasts. Rheumatoid arthritis (RA) is an autoimmune disease in which the body’s immune system attacks its own tissue. eg Patients are taught how to protect the joints during routine daily life; adjusting their movement-behaviour; behavioural change by your patient (a process with 3 phases: the motivation-phase, the initial-behavioural change phase and the phase where the intended behaviour is continued).
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