Gyakorlatok GPA-nál (Wegener) — indukció-pihenés, fenntartás-fokozatos, fertőzés-megelőzés KRITIKUS

ACR/EULAR 2022 classification + 2021 EULAR/ERA management framework. Granulomatosis with polyangiitis (formerly Wegener's granulomatosis) is an ANCA-associated small-vessel vasculitis with the classic triad: upper airway (saddle-nose deformity from cartilage destruction, chronic sinusitis, otitis), lower respiratory (cavitating nodules on CT, alveolar hemorrhage), and glomerulonephritis (rapidly progressive in severe disease). PR3-ANCA is the classic serology. Treatment is phased — cyclophosphamide or rituximab for induction, methotrexate / MMF / rituximab for maintenance. Exercise programming is phase-aware: during induction with severe systemic disease and high-dose steroids + cytotoxic immunosuppression, exercise is limited to rest + gentle range-of-motion + chair-based functional; during maintenance with stable disease, graded aerobic + light strength is appropriate and reduces deconditioning that compounds disability. Cardiovascular risk is elevated. Steroid-induced osteoporosis is common from chronic prednisone. Opportunistic infection risk on cyclophos/rituximab is the major exercise-environment safety lever — AVOID crowded gyms during induction + flu/COVID/pneumococcal/zoster vaccines per rheum + early call for fever.

Volya's catalogue carries the foundation moves: supported-glute-bridge for posterior chain low-intensity work, wall-push-up for scaled upper-body strength, scapular-retraction for posture (chronic disease + steroid changes), cat-cow for spinal mobility, supine-knee-to-chest for low-back release, diaphragmatic-breathing for parasympathetic + chest-wall mobility + pulmonary mucus clearance, pursed-lip-breathing for dyspnea + cavitating nodule management, standing-march for managed cardio (maintenance phase), ankle-pump for circulation + DVT prevention. The AI coach also knows the nutrition side — Mediterranean anti-inflammatory backbone (Bichara 2024 review), renal modifier low-sodium <2 g/day + protein moderate during active disease per nephrology, iron + folate + B12 check (anemia common), vitamin D often low target 40-60 ng/mL, calcium 1000-1200 + vitamin D + weight-bearing for steroid osteoporosis, infection prevention CRITICAL (food safety: AVOID raw/undercooked + unpasteurized + raw sprouts + soft mold cheeses), AVOID grapefruit + Seville orange (cyclophos + tacrolimus + cyclosporin interactions), cyclophos bladder protection ≥3 L/day fluids + frequent voiding on infusion days, methotrexate folic acid 1-5 mg/day per rheum, AVOID alcohol with methotrexate hepatotoxicity. CRITICAL: Vasculitis Foundation + Vasculitis Patient-Powered Research Network (V-PPRN) + ACR + rheumatology + nephrology + pulmonology + ENT + ophthalmology if scleritis + infectious disease for opportunistic infection coverage. This is NEVER a replacement for rheumatology + multispecialty care.