REGISTRO DOI: 10.69849/revistaft/ni10202411192205
Micaela Martins de Almeida Lemes1; Ana Flávia Spadaccini2; Douglas Fernandes Silva3
ABSTRACT
INTRODUCTION: Autoimmune diseases constitute a heterogeneous group of conditions characterized by an aberrant immune response, where the immune system targets the body’s own tissues, resulting in inflammation and damage across various organs and systems. These pathologies significantly impact patients’ quality of life, making symptom management and functional enhancement critical. Physiotherapeutic interventions have emerged as an effective strategy for symptom control and quality of life improvement in these patients. OBJECTIVE: Investigate through current literature the action of physiotherapy in patients with autoimmune diseases. METHODOLOGY: Literature review using the main databases. RESULTS AND DISCUSSION: The study showed that physiotherapeutic interventions, such as muscle strengthening and stretching, improve the quality of life of patients with autoimmune diseases. There was a significant reduction in symptoms such as pain and fatigue, in addition to less need for medication, highlighting the importance of physiotherapy as a complement to treatment. CONCLUSION: Physiotherapy interventions play an essential role in the management of autoimmune diseases, providing symptom relief, improving physical function and quality of life. Integration of these interventions into standard healthcare is critical to the effective treatment and rehabilitation of patients with these conditions.
Keywords: Autoimmune Diseases; Physiotherapy Interventions; Rehabilitation; Quality of Life.
1. INTRODUCTION
Autoimmune diseases constitute a heterogeneous group of conditions characterized by a dysfunctional immune response, in which the body’s immune system attacks healthy tissues (Rose; Mackay, 1985). Dal Pozzo Comi et al. (Dal Pozzo Comin; Santos Gomes Jorge., 2016), physiotherapeutic interventions play a fundamental role in the management of autoimmune diseases, offering substantial benefits in reducing symptoms and improving patients’ quality of life. Autoimmune diseases often result in chronic pain, fatigue, and functional limitations that directly impact the quality of life of affected individuals.
Autoimmune diseases can be diverse and act in different ways, among them we can mention multiple sclerosis, rheumatoid arthritis, systemic lupus and scleroderma (Lima et al., 2024). Management of these conditions is challenging, as the chronic and progressive nature of autoimmune diseases often results in functional limitations, chronic pain, and impaired quality of life.
Rehabilitation in physiotherapy, regardless of the pathology, aims to improve the patient’s quality of life and minimize disability with the aim of fully recovering the patient (Flachenecker, 2012). According to the same authors, if full recovery is not possible, the focus is on achieving the highest possible quality of life potential. To this end, rehabilitation involves a specialized multidisciplinary assessment, programs aimed at specific objectives and measuring the impacts of these interventions on the patient. These assessments should use measures that are clinically appropriate and scientifically supported.
A comprehensive review of the literature on exercise interventions for individuals with physical and cognitive disabilities found a wide range of 80 different interventions, including aerobic, strength and a combination of both. However, only 32 of these interventions have been tested in clinical trials. Most studies have focused on conditions such as stroke, Multiple Sclerosis (MS) and intellectual disability, with less attention given to other pathologies. This diversity and the lack of consistent evidence limit the generalizability of the results and indicate the need for further, more powerful studies (Flachenecker, 2012).
Physiotherapy, according to Lima et al. (LIMA et al., 2024), has a crucial role in the management of autoimmune diseases as an integral part of the multidisciplinary health care team. Dal Pozzo & Santos Gomes (Dal Pozzo Comin; Santos Gomes Jorge, 2016) claim that through personalized interventions, physiotherapists aim to reduce inflammation, relieve pain, improve joint mobility and strengthen weakened muscles. Thus, techniques such as kinesiotherapy, stretching exercises, strength training, manual therapy and hydrotherapy are commonly used to achieve patient recovery (Flores Nogueira et al., 2009).
Literature demonstrates that regular physiotherapy intervention can have a significant impact on the quality of life of patients with autoimmune diseases (Dal Pozzo Comin; Santos Gomes Jorge, 2016). Pain relief, which is one of the main factors compromising the quality of life of these patients according to the author Flachenecker (Flachenecker, 2012), which is often achieved through targeted exercises and muscle relaxation techniques. In addition, improved functional capacity allows patients to perform activities of daily living with greater independence, reducing dependence on others and increasing self-esteem.
In addition, another important aspect is the promotion of psychological well-being, as physiotherapy contributes to reducing levels of anxiety and depression, common in patients with autoimmune diseases, through encouraging the practice of physical activities and the support offered during treatment sessions (Jorge; Comin; Wibelinger, 2016). According to the same authors, active participation in one’s own treatment, promoted by physiotherapy, is also a positive factor, as it encourages the patient to maintain a healthier and more active lifestyle.
Considering the increase in the number of diagnoses of autoimmune diseases and the continuous search for more effective therapeutic strategies, this study is justified by the need to deepen knowledge about the impacts of physiotherapeutic interventions on the quality of life of these patients (Miller, 2023). Therefore, the management of autoimmune diseases constitutes a substantial challenge for both patients and health professionals, due to the complexity and chronicity of these conditions. This study conducted a literature review on physiotherapeutic interventions applied in the management of autoimmune diseases, with an emphasis on the impacts of these approaches on patients, quality of life. Furthermore, the work aims to identify gaps in the existing literature and suggest directions for future research in the area.
2. PATHOPHYSIOLOGY OF AUTOIMMUNE DISEASES AND THEIR FUNCTIONAL IMPLICATIONS
Rheumatoid arthritis (RA) is a chronic inflammatory disease that predominantly affects the joints, resulting in bone erosion, cartilage destruction and joint deformities. The pathology involves an immune response directed against the synovial membrane, leading to synovitis and consequent joint destruction (Smolen; Aletaha; Mcinnes, 2016). Table 1 presents a summary of the description of pathophysiologies.
Tabela 1: Description of the PATHOPHYSIOLOGY OF AUTOIMMUNE DISEASES (ROSE; MACKAY, 1985).
| DISEASES | COMMITMENTS |
| Rheumatoid arthriti. | Chronic inflammation of the joints and destruction of joints and bones. |
| Multiple sclerosis | Muscle weakness, imbalance, muscle stiffness, pain and difficulty walking. |
| Systemic lupus erythematosus | Pain, swelling in the joints and difficulty breathing. |
| Scleroderma | Thickening of the skin and stiffness of organs and joints, difficulty breathing, muscle pain and weakness. |
Multiple sclerosis (MS) is a disease that also has implications in pathophysiology, which in turn is an autoimmune neurological disease that affects the central nervous system, causing demyelination and loss of axons. MS can cause a variety of motor, sensory and cognitive deficits, depending on the areas of the brain or spinal cord affected (Thompson et al., 2018).
Another example is systemic lupus erythematosus (SLE), a systemic autoimmune disease characterized by the production of autoantibodies that can affect multiple organs, including the skin, kidneys, heart, and joints. SLE manifests itself through widespread inflammation and tissue damage and can result in several systemic complications (FAVA; PETRI, 2019). Therefore, there is a need for interaction with physiotherapists. Scleroderma is an autoimmune disease characterized by thickening and hardening of the skin, resulting from excessive collagen production. In more severe cases, it can affect internal organs, such as the lungs, heart and digestive tract. Scleroderma is divided into two main types: limited and diffuse, depending on the extent of cutaneous and systemic involvement. Vascular dysfunction and collagen accumulation result in progressive tissue fibrosis, leading to joint stiffness, limited movement and respiratory and gastrointestinal dysfunctions (Allanore et al., 2015).
The impact of these autoimmune diseases on mobility and physical function is profound. In rheumatoid arthritis, for example, chronic inflammation of the joints leads to loss of range of motion, muscle weakness, and often disability. Motl and Sandroff (Motl; Sandroff, 2015) comment in their work that patients with multiple sclerosis often experience extreme fatigue, muscle spasticity and weakness, resulting in difficulties in carrying out daily activities.
In all these conditions, mobility is compromised by the presence of pain and reduced physical function. Persistent inflammation promotes structural damage to joints and tissues, resulting in progressive deterioration of muscle strength and motor coordination. In the case of systemic lupus erythematosus (SLE), for example, the occurrence of polyarthritis and myositis can restrict mobility and lead to muscle atrophy (Alves et al., 2012). A common symptom of autoimmune diseases is pain, which is usually associated with the chronic inflammatory process. In rheumatoid arthritis, for example, the accumulation of pro-inflammatory cytokines, such as tumor necrosis factor-alpha and interleukins, promotes the activation of nociceptive pathways, resulting in chronic pain (Fang et al., 2023).
In addition, according to Fang et al. (Fang et al., 2023) chronic inflammation affects peripheral nerve fibers, leading to changes in pain perception and, in some cases, the development of hyperalgesia and allodynia. This complex relationship between inflammation and pain is particularly evident in multiple sclerosis, where neuroinflammation induces both neuropathic pain and motor dysfunction.
In this way, understanding the pathophysiology can guide clinical practice and the development of more efficient therapeutic protocols, promoting more comprehensive and patient-centered health care. Physiotherapists, therefore, play an essential role in the treatment of autoimmune diseases, working on rehabilitation and improving patients quality of life.
3. PHYSIOTHERAPEUTIC INTERVENTIONS IN THE TREATMENT OF AUTOIMMUNE DISEASES AND THEIR IMPACT ON QUALITY OF LIFE
Kinesiotherapy consists of therapeutic exercises focused on maintaining or improving joint mobility and muscle strength and is widely used in the treatment of autoimmune diseases such as rheumatoid arthritis and multiple sclerosis. These exercises help prevent contractures and loss of muscle strength, which are often associated with inactivity caused by joint pain and stiffness (Flores Nogueira et al., 2009). This practice acts directly on symptoms, helping to preserve joint function and slowing the progression of deformities. In conditions such as multiple sclerosis, kinesiotherapy exercises help to prevent muscle atrophy and improve motor coordination, contributing to the ability to perform daily activities more independently (Moura et al., 2023).
In patients with rheumatoid arthritis, kinesiotherapy promotes improved joint flexibility and helps reduce the progression of joint deformities. Studies indicate that muscle strengthening exercises contribute to reducing fatigue and improving functionality, allowing patients to maintain greater independence in their daily activities (Dal Pozzo Comin; Santos Gomes Jorge, 2016). In patients with multiple sclerosis, regular kinesiotherapy can improve gait and reduce the risk of falls, contributing to increased mobility and quality of life (Motl; Sandroff, 2015).
Manual therapy, including joint mobilization techniques, massage, and soft tissue manipulation, has been used to relieve pain and improve physical function in patients with autoimmune diseases. In conditions such as scleroderma, where tissue fibrosis causes stiffness and loss of function, manual stretching and mobilization techniques can help maintain joint flexibility and reduce pain (Schwartz et al., 2019). Thus, this technique, which includes joint mobilization techniques, stretching and soft tissue manipulation, is particularly effective in treating chronic pain associated with autoimmune diseases.
In rheumatoid arthritis, for example, manual therapy is effective in relieving joint pain and morning stiffness, providing greater mobility and functional capacity throughout the day (Delimar; Vukorepa, 2021). The mechanisms include pain modulation through stimulation of mechanical receptors and the promotion of muscle relaxation that contributes to the overall improvement of the patient’s physical condition.
Hydrotherapy, another action taken by physiotherapists, uses exercises performed in water. It is a treatment modality that offers several advantages for patients with joint problems. The buoyancy of the water reduces the impact on the joints, allowing patients to perform movements with less pain and greater range of motion. In addition, the resistance offered by the aquatic environment creates an environment that is favorable for muscle strengthening without overloading the joints. (Corvillo et al., 2017).
In patients with systemic lupus erythematosus and rheumatoid arthritis, hydrotherapy has been shown to be beneficial in reducing pain and improving joint mobility. The temperature of the water, usually heated, also promotes muscle relaxation, reducing spasms and joint stiffness (Al‐Qubaeissy et al., 2013). Another relevant benefit is the feeling of safety provided by the aquatic environment, which facilitates the execution of exercises, especially in patients with balance and coordination impairments, such as those with multiple sclerosis (Corvillo et al., 2017). Lupus patients can perform movements with greater amplitude and less pain during hydrotherapy sessions (Karuline Alves Moreira; Valença Brito; Kristine Lourenço, 2019). Heated water promotes muscle relaxation and relieves pain, providing short-term relief and increasing patient adherence to other therapeutic modalities.
Physiotherapy has a significant impact on the psychological well-being of patients with autoimmune diseases, as well as directly influencing physical function and pain control. Regular exercise, such as kinesiotherapy and hydrotherapy, promotes the release of endorphins, which regulate mood and reduce anxiety and depression, conditions often present in patients with chronic diseases (Karuline Alves Moreira; Valença Brito; Kristine Lourenço, 2019).
By actively engaging patients in the recovery process, physical therapy fosters an essential interaction between patient and physical therapist, which is essential for emotional support. This collaboration in physical therapy increases self-efficacy, control over one’s own health, and a sense of overall well-being (Carek; Laibstain; Carek, 2011). Table 2 summarizes the physiotherapeutic approaches to patients’ quality of life.
Tabela 2: Physiotherapeutic approaches and impacts on quality of life(FLORES NOGUEIRA et al., 2009; SCHWARTZ et al., 2019; CORVILLO et al., 2017; CAREK; LAIBSTAIN; CAREK, 2011).
| INTERVENTIONS | OBJECTIVES | BENEFITS | DISEASES |
| Kinesiotherapy | Maintain joint mobility and muscle strength. | Prevents contractures and atrophy. | Rheumatoid arthritis. |
| Manual Therapies | Relieve pain and physical function. | Uses mobilizations and drainage and release techniques to reduce edema, pain and improve ROM | Systemic lúpus erythematosus |
| Hydrotherapy | Reduce impacts on joints. | Helps reduce joint stress, increase relaxation and mobility. | Scleroderma |
| Physiotherapy in general | Help the patient’s overall well-being. | Improves the patient’s quality of life by promoting physical and psychological well-being. | Autoimmune diseases in general |
4. FUTURE PERSPECTIVES AND INNOVATIONS IN PHYSIOTHERAPEUTIC INTERVENTIONS FOR AUTOIMMUNE DISEASES
Emerging technologies such as telephysiotherapy and virtual reality are transforming the field of autoimmune disease rehabilitation. Telephysiotherapy allows patients with mobility limitations or living in remote areas to receive quality care through digital platforms. Studies indicate that virtual rehabilitation can be as effective as conventional in-person treatments, especially when it comes to maintaining mobility and muscle strength in patients with multiple sclerosis or rheumatoid arthritis (Stavrakidou et al., 2023).
The use of virtual reality in physical therapy has shown promising results in increasing patient motivation and improving physical performance. Patients with lupus and other autoimmune conditions often experience chronic fatigue and poor adherence to rehabilitation programs. Integrating therapeutic games and immersive environments into rehabilitation can make treatment more engaging, aiding in consistent patient adherence to physical therapy programs (Ra et al., 2021).
Personalizing healthcare based on biomarkers and health data has the potential to transform the treatment of autoimmune diseases. With the advancement of data analysis and genetic sequencing technologies, it is feasible to develop tailored physiotherapy approaches, adjusted to the individual characteristics of each patient, such as inflammatory response and disease progression. The use of biomarkers allows the identification of patterns of response to treatment, guiding the selection of specific interventions, such as the type and intensity of exercises or manual techniques most appropriate for each patient. This approach can increase the effectiveness of physiotherapy interventions and minimize adverse effects or ineffectiveness in patients with complex conditions, such as lupus and rheumatoid arthritis (Abdelhafiz et al., 2023).
The use of artificial intelligence to analyze health data is also being explored to predict individual responses to therapies, making care more efficient and personalized (Truijen et al., 2022). According to the same authors, artificial intelligence (AI) can help identify complex patterns in patient data, allowing interventions to be personalized according to the specific needs of everyone, which can result in better clinical outcomes and optimization of health resources. In addition, this technology has the potential to reduce the time required for diagnosis and treatment selection, favouring a more agile and precise approach to the management of various health conditions.
Public policies play a key role in the accessibility and dissemination of physiotherapy treatments for autoimmune diseases. In many countries, the implementation of public health programs focused on rehabilitation for chronic diseases has increased access to physiotherapy care for vulnerable populations. However, significant challenges remain in terms of equity and distribution of resources. Reimbursement policies and health insurance coverage are also essential for these technological innovations to be implemented in a sustainable manner and accessible to all patients, regardless of their location or economic status (Biomédico; De; Florentino, 2016).
Additionally, the advancement of legislation that encourages the inclusion of innovative treatments, such as the use of augmented reality and the application of personalized health data in the management of autoimmune diseases, can ensure that physiotherapy keeps up with technological innovations and continues to provide significant benefits to patients (Ra et al., 2021).
5. CONCLUSIONS
Physiotherapeutic interventions, as observed in this work, are fundamental in the treatment of autoimmune diseases due to their direct influence on patients’ quality of life. Physiotherapy significantly reduces debilitating symptoms such as pain and fatigue. It also helps to improve functional capacity and increase self-confidence. As the literature demonstrates, physiotherapy approaches act preventively against secondary complications such as contractures and deformities and play a crucial role in the recovery and maintenance of mobility. Dissemination of correct and accessible information about the benefits of physiotherapy and patient involvement in treatment are fundamental to the successful management of the disease. In this context, the physiotherapist plays an essential role both in the execution of therapeutic interventions and in the education of patients and their families, offering guidance on how to deal with the challenges of autoimmune diseases. Humanized care, focused on comprehensive well-being, is essential to promote autonomy, functionality and a better quality of life.
6. ACKNOWLEDGMENTS
The authors would like to thank UNIFIO.
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1Department of Physiotherapy – University Center of the Integrated Faculties of Ourinhos – Unifio, Ourinhos, SP, Brazil.
ORCID: 0009-0006-6106-5344
micaelamartinsdealmeidalemes@gmail.com
2Department of Physiotherapy – University Center of the Integrated Faculties of Ourinhos – Unifio, Ourinhos, SP, Brazil.
ORCID: 0000-0002-4747-4006
ana.spadaccini@unifio.edu.br
3Department of Physiotherapy – University Center of the Integrated Faculties of Ourinhos – Unifio, Ourinhos, SP,Silva
ORCID: 0000-0002-0252-1112
douglas.silva@unifio.edu.br