Significance of Immunomodulating Agents in Rehabilitation

Therapists also deal with the rehabilitation of musculoskeletal disorders that are caused by an autoimmune response. Many of these diseases attack connective tissues, and autoimmune diseases such as rheumatoid arthritis, dermatomyositis, and systemic lupus erythematosus are often the primary reason that patients undergo rehabilitation. Patients with a compromised immune system may develop musculoskeletal problems related to their immunodeficient state. Hence, immunomodulating drugs are frequently used in many patients receiving physical therapy and occupational therapy. 

The most significant impact of these drugs on rehabilitation is related to their side effects, especially those of the immunosuppressants. These drugs are typically used in high doses to produce immunosuppressive effects, which are often achieved at the expense of serious and toxic side effects. Many immunosuppressants, especially the glucocorticoids, exert catabolic effects on bone, muscle, and other tissues. Other immunosuppressants, such as cyclosporine and tacrolimus, are neurotoxic and may cause peripheral neuropathies and CNS-related problems in balance and posture. 

Brief History. A.S. is a 47-year-old concert musician who experienced a progressive decline in renal function that ultimately led to renal failure. Kidney function was maintained artificially through renal dialysis until a suitable kidney transplant became available from a donor who died in an automobile accident. The kidney was transplanted successfully, and A.S. was placed on a prophylactic regimen of three different immunosuppressive drugs to prevent the rejection of the transplanted kidney. At the time of the transplant, cyclosporine was initiated at a dosage of 10 mg/kg of body weight 

Decision/Solution. Gentle resistance exercises were initiated in the ICU as soon as the patient was alert and could follow basic instructions. Strengthening exercises were progressively increased using manual resistance, and various weights and exercise machines were incorporated into the strengthening regimen as tolerated by the patient. The thera- 

Our knowledge of how the immune system functions in both normal and disease states has increased dramatically over the last several decades, and we now have drugs that can moderate the effects of the immune response in certain clinical situations. Immunosuppressants are a mainstay in preventing tissue rejection, and much of the current success of organ transplants is due to the judicious use of immunosuppressive drugs. These drugs are also beneficial in a number of diseases that have an autoimmune basis, and immunosuppressants can help alleviate symptoms or possibly even reverse the sequelae of certain diseases 

---