Rehabilitation, in a general sense, has developed as a counter measure against both physical and mental functional disturbances which have remained or nearly stabilized by usual medical treatments given on a disease or a trauma. Accordingly, it is apt to be regarded as a measure which should be started after confirmation of symptomatic stabilization or the stabilization of functional disturbances. Rheumatoid arthritis is a disease difficult to expect symptomatic stabilization and its functional disturbances are always progressive causing an important problem in the social rehabilitation of such patients. It is a disease, moreover, difficult to decide when to start rehabilitation. This is the reason why patients of rheumatic disorders occupy only 2% of the total patients of physical disturbances taken care by the rehabilitation centers existing in each districts all over Japan. On the contrary, 16.9% of heavy cases of physical disturbances hospitalized in wo national sanatoria, which are taking care of medical rehabilitation, are the patients of rheumatic origin. Rehabilitation of rheumatic disorders, therefore, should be performed in conjunction with general medical treatments.
Patients of rheumatoid arthritis are apt to become depressed by severe pain and stiffness, and it has become difficult to motivate them for rehabilitation. This depressed state, however, is symptomatic and disappears in most cases by removal of pain and stiffness. For this purpose, adreno-cortico-steroids are positively effective. These steroids, moreover, have a psychomotor stimulating effect, and their intra-articular injections facilitate rehabilitation as well. Prolonged administration of steroid hormons may sometimes invite development of side effects. In a considerable number of cases, administration of steroids has become indispensable. Even intra-articular injections may cause aggravation of weight loaded joints by an excessive use of such joints.
Some people prefer salicylates or butazolidin preparations to steroids.
Physiotherapies, especially hot water and massage are the measures indispensable for removal of pain in rheumatic patients though both of them have begun to lose their positions as the most valuable measures in rehabilitation program.
The next is orthopedic surgery like synovectomy or to provide a window. There is a lot to expect from the orthopedic surgery of deformed joints. Further developments of counter measures against deformed joints are strongly desired.
It is not easy to set a goal of rehabilitation for patients of rheumatic disorders. If expected too much, the patient must suffer from a heavy psychological burden and may precipitate reccurence or exacerbation and sometimes even cardic complication. Too much burden may spoil invalid joints involved. On careful investigation of the daily lives of rheumatic patients, it was found that they do not always have an optimisitic future.
At present, in Japan, there exists a considerable gap between the progress in medical insurance and the socio-economical programs of rehabilitation causing the patients of chronic diseases like rheumatoid arthritis to remain in medical facilities without having adequate employments. It is considered to be an utmost imprortance to provide ways to accept these patients in society, and also to establish hospitals specialized in rheumatic disorders including rehabilitainon.