Introduction

Chartered Physiotherapists, those registered with the Health Professions Council UK, are equipped to respond to the needs of lupus patients through effective and appropriate assessment of specific problems identified by individuals. Symptoms vary within and across patients and so it is important to identify the specific concerns, along with a careful consideration of the general features that may be apparent at assessment. Good clinical judgement should lead physiotherapists to determine how they might provide effective management and suitable treatment options based upon best evidence available to them. Therapy and rehabilitation goals should aim at increasing efficiency in activity, with a view to maintaining and improving quality of life.

Management and Treatment

At assessment, clinicians will engage in a two-fold process. They will approach lupus as a multi-system disease affecting many tissues and organ systems whilst evaluating the consequence of these changes on a person’s life style and their possible aspirations. A diligent review of these factors will contribute in some measure in proposing physiotherapeutic management and other treatment.

The aim of the physiotherapist in the care of the lupus patient will be to provide:

• Appropriate, ongoing assessment of individuals and management of key clinical features and symptoms
• Propose and agree possible therapeutic strategies with service users and carers
• Consider means for future access and review

It is understood that around 60% of people with lupus describe muscle pain, muscle weakness and tenderness. About 90% have some evidence of arthritis and associated joint problems. These compound the experience of day-to-day living. Confronted by such issues, the physiotherapist in discussion with the service user may opt for one, or a combination, of the following:

• Management of inflammation and the principles of joint protection
• Pain Management
• Encourage and facilitate efficient movement
• Appropriate (aerobic) exercise prescription
• Energy conservation
• Possible ergonomic advice for home, the work place or leisure
• Other coping techniques, stress reduction and relaxation strategies
• Education of carers and others

Physiotherapists have a variety of manual skills and other management and treatment modalities as part of their therapeutic provision. These will be considered carefully and on an individual basis in discussion with the service user (along with their carers where appropriate). They may include exercise prescription, activity to promote efficient movement, improving exercise capacity and encouraging good posture and functional movement. Alongside, the use of other modalities that promote pain relief, reduce joint stiffness, reduce muscle discomfort and encourage relaxation will be considered. Other therapeutic modalities, including use of electrotherapy and hydrotherapy can be used to assist pain relief and reduce the effects of inflammation.

Some of the treatments available include:
• TENS
• Heat
• Hydrotherapy
• Appropriate Manual Therapy
• Acupuncture

Increasingly, the move within healthcare is to involve patients at every stage of their care and so lupus patients should reasonably expect both treatment and assistance in developing and appraising self-management skills so they can cope with daily life, demands and choices. Modern healthcare encourages a partnership approach and liaison/consultation with occupational therapists (and other health professionals) may be essential in terms of further specialist advice and expertise. Such items as working/ resting splints and other aids/equipment may be necessary for home and work life; these may be better provided through occupational therapy or orthotic services.

General Practitioners should consider referring their lupus patients to Physiotherapy Services; these are often available locally within local rehabilitation day units or health centres. In some areas specific lupus clinics and services will be available. It is worth investigating what local provision can offer.

Clive Liles
Programme Director BSc Physiotherapy (Hons)
School of Sport, Exercise and Rehabilitation Sciences
University of Birmingham
Edgbaston
Birmingham, B15 2TT