[Principles of extra-articular rheumatic diseases treatment--therapeutic dilemmas and treatment algorithms]

Soft tissue disorders are often neglected during the course of the rheumatic diseases. Extra-articular rheumatism, that includes all inflammatory clinical entities inside tendons, synovial sheaths, entheses, bursas and muscles, is a common reason of disability in patients and is accompanied by pain and loss of function in the involved region. This paper was designed to look for evidence based medicine data on recommendations in treatment of extra-articular rheumatism as well as finding scientifically validated treatment algorithms. In systematic reviews available by searching specialised medical databases such as The Cochrane Collaboration Database and Physiotherapy Evidence Database (PEDro) there are no studies on comparison of different treatment algorithms on the same extra-articular disease. In systematic reviews only the studies that compare one modality of non-pharmacological treatment to another or to placebo are included, because of statistical analysis. Treatment algorithms are found only as proposals in individual papers and are different from institution to institution. The current trend is to renew the knowledge in treatment modalities of soft tissue disorders every five years due to the advancement of technological capabilities of medical equipment.