Archives

Because of Arthrex’s over 30 years of expertise, “ACP-PRP” therapy at the LifePLus Polyclinic in Tirana has reached the highest levels.

With approximately 3000 workers globally in research, development, and sales, this organization has played and continues to play an important role in creating innovative therapies for various joint diseases. Arthrex is currently recognized as the industry leader in reconstructive orthopedic surgery.

Healing injured or inflamed tissues entail a number of intricate natural processes that the body has perfectly tailored. Platelets (blood platelets) are crucial in this process. They release growth factors at the site of injury, which stimulate the repair of damaged tissue and prevent unpleasant inflammatory processes. The whole mechanism of “ACP-PRP” Therapy (Autologous Conditioned Plasma – Platelet Rich Plasma) is based on these processes.

This therapy powerfully and quickly helps the self-healing processes of the human body due to the high concentration of growth factors.

WHEN SHOULD ACP-PRP THERAPY BE USED?

• IN THE EVENT OF SPORTS INJURY – If you are currently in a process of rehabilitation or being treated for a sports injury, this therapy can help your body’s healing processes. Most locomotor system injuries, including ligaments and tendons, as well as muscle and tendon injuries, can benefit from ACP.
• IN THE TREATMENT OF OSTEOARTRITIS – Osteoarthritis often limits physical exercise. Early-stage osteoarthritis symptoms include joint pain and morning stiffness. Another common symptom is soreness after short walks following periods of inactivity. These symptoms are caused by articular cartilage degradation. ACP-PRP treatment has been demonstrated to be very effective in treating patients with mild to moderate (Grade I-III) osteoarthritis symptoms.
• IN THE PATIENT’S POST-OPERATIVE PHASE – The use of this therapy in the post-operative phase, due to growth factors and self-healing processes, produces ideal circumstances for the patient to recover much faster.

HOW DOES THE THERAPY PROCEDURE WORK?

• Blood is drawn from a vein in the patient’s arm.
• A centrifugal and separation procedure extracts and concentrates the desired substances of the body (ACP – Processed Autologous Plasma);
• The desired substances are then injected into the affected area.

ADVANTAGES FOR THE PATIENT:

• It is an outpatient operation;
• The process is very quick (less than 30 minutes);
• The active substance is derived from the patient’s own body. As a consequence, it is very well accepted and gives noticeable results in a short period of time.

Today, the term “gout” refers to a complex group of diseases occurring only in humans, which include:

• hyperuricemia (increased serum uric acid values);
• recurrent attacks of arthritis, induced by uric acid crystals;
• presence of accumulation of uric acid salts around the joints;
• kidney damage & kidney stones from uric acid.

“It is caused by overproduction or a malfunction in the clearance of uric acid from the kidneys,” explains Dr. Ervin, who visits the LifePLus Polyclinic in Tirana on a daily basis and provides specialist therapy for rheumatic and autoimmune diseases based on the most recent international protocols. Gout is an integral part of several diseases, including diabetes, hypertension, obesity, and dyslipidemia. Gout begins with intense pain (typically in the ankles), but it can also affect other joints and is accompanied by swelling, pain on the touch, local heat, and redness. “The patient can refer to similar attacks in the past”, explains Dr. Ervini.

The presence of uric acid crystals or tufts in the articular fluid confirms the diagnosis. Gout therapy can be managed in two ways: medicated or non-medicated. Dr. Ervin believes that educating patients through diet and lifestyle changes is equally as essential as pharmacological therapy. “Drug therapy takes on a specific importance in some special instances,” he explains. The following are some diets for those who have gout (podagral):

HYPERURICEMIA / GUT DIET

Gout attacks e can be prevented and avoided by eating a nutritious diet. “By avoiding or reducing the intake of foods high in purines, it is possible to reduce serial levels of urate and prevent gout episodes,” Dr. Ervini emphasizes. Purines are naturally occurring chemicals found in every cell of the body as well as in all foods. “They’re in the chemical structures of our DNA, as well as plant and animal genes,” he says. Some foods have high purine concentrations, and these foods are frequently strong in protein

DIET DURING A GUTTY ATTACK

• Drink 2-3 liters of fluids every day, half of which should be water.
• Stop using alcohol. If taking it is necessary, use red wine (approximately 200 cc/day);
• Consume foods with low (or moderate) purine levels.
• Use moderate amounts of protein where recommended: tofu, dairy products, eggs, peanut butter, etc. 
• Use foods high in carbohydrates: bread, cereals, rice, vegetables and fruits;
• Limit fats and replace them with fish, chicken, etc.

DIET FOR CHRONIC GUT

• Drink 2-3 liters of fluids a day, half of which should be water;
• Continue to avoid or restrict alcohol usage. Red wine (200 cc/day) is advised.
• Use foods with moderate and low purine levels. Avoid purine-rich meals.
• Maintain consistent and healthy body weight.
• Do not gain weight since being overweight promotes uric acid production. If you need to lose weight, you should aim to lose 0.5-1 kg every week.
• Avoid high protein diets, as they aggravate gout.

A GLUCOSE DIET MODEL

• Breakfast: oranges, peaches, apples, mangoes, figs, whole wheat bread, buttermilk;
• Lunch: celery, beets, lentils, turnips, cabbage, tomatoes, carrots, squash, potatoes, whole wheat bread, buttermilk, homemade cheese;
• Dinner: beans, cabbage, tomatoes, carrots, wheat bread, buttermilk.

Interview with rheumatologist Dr. Ervin Rapushi, about one of the most frequent diseases, that requires an early diagnosis and special treatment: Ankylosing spondylitis.
Dr. Ervin visits the LifePlus Polyclinic in Tirana every day and offers specialized treatment for Ankylosing Spondylitis and a range of rheumatic or autoimmune diseases based on the best contemporary protocols.

What exactly is Ankylosing Spondylitis, Dr. Ervin?

Ankylosing spondylitis is an inflammatory disease that affects the spine, causing fusion of certain vertebrae or joints, and damage to total destruction. These injuries to the spine and joints cause pronounced and debilitating abnormalities that affect organ and system function and significantly degrade the quality of life. Injuries to the spine lead to its deformation until the body bends in the forward position. Touching the chest makes breathing and heart function harder.

What are some of this disease’s symptoms?

Men are more likely than women to be affected by ankylosing spondylitis.
Signs and symptoms usually begin in late or early adolescence.
The pain begins with inflammatory type pain in the lower back, which implies discomfort in the early hours of the morning that is reduced by movement, aggravated by posture, and relieved by anti-rheumatic drugs.
In many cases, the disease begins by touching the neck or even the joints, particularly major ones (coxofemoral, genu, talocrural, etc.). Ankylosing Spondylitis can cause catastrophic damage to the eyes, lungs, kidneys, and nerves over time.

The area’s most often affected are:

• Articulation between the lower back and the pelvis (sacroiliac);
• Lumbar, thoracic, and cervical vertebrae
• Entesis refers to the attachment of tendons and ligaments to the bone, which occurs mostly in the spine but can also occur along the back of the heel.
• Cartilage between the sternum and the thoracic plate;
• Hip (coxofemoral) and shoulder joints.

What causes this disease?

Ankylosing spondylitis has no specific known cause; however, hereditary factors have been implicated. People who have the HLA-B27 gene, in particular, are at a substantially increased risk of acquiring this condition. However, only a few people who carry this gene are more likely to acquire the condition.

Dr. Ervin, what are the different types of Ankylosing Spondylitis diagnoses?

During the physical examination, we assess the shape of the spine and see the mobility of its various parts through special tests. In this way, we can analyze the extent of its impact, while also assessing the disease’s involvement in the joints. 
Through examinations, we also evaluate the touches of different organs or systems, as well as formulate a follow-up plan with consultations and other specialties to evaluate these touches.
A) IMAGING TESTS – Radiographs of the pelvis, joints, and spine allow us to check for changes in the patient’s joints and bones, even if there are no evident indicators of Ankylosing Spondylitis at the start of the disease. Magnetic resonance imaging (MRI) remains the gold standard for evaluating spinal or articular involvement in the early stages.  MRI is a non-harmful radiation-free examination that is also reasonably priced.
B) B) LABORATORY TESTS – There are no specific laboratory tests to identify Ankylosing Spondylitis.
Some blood tests can check for markers of inflammation as an indicator of disease activity (PCR, Fibrinogen, erythrosendimentation), however, they can also be compromised by a variety of health issues.
Blood can be tested for the HLA-B27 gene, although Ankylosing Spondylitis can exist even if this gene is negative in 25% of cases. Its presence, however, confirms the diagnosis.

What are the different types of treatment?

The goal of therapy is to relieve pain and stiffness while also preventing or delaying complications and deformities.
Ankylosing Spondylitis treatment is most effective before the illness causes irreparable damage.

MEDICATIONS

Nonsteroidal anti-inflammatory drugs (NSAIDs) – such as naproxen, indomethacin, piroxicam, and ketoprofen – are commonly used medications to treat Ankylosing Spondylitis.  They can relieve inflammation, pain, and stiffness of the patient.  They can be combined very well depending on the touch with glucocorticoids (cortisone), analgesics, and muscle relaxants. When the disease has impacted the joints, it is preferable to combine these medicines with methotrexate.
In case these drugs fail to control this disease, it is suggested to combine them with biological preparations such as tumor necrosis factor blockers (TNF) (Adalimumab – Humira, Infiximab – Remicade, Etanercept – Enbrel, Certolizumab pegol – Cimzia, Golimumab – Sympone) or interleukin 17 (IL-17) inhibitors (Secukinumab – Cosentyx). These preparations have made it possible to control disease activity. To prevent bone deterioration and additional skeletal involvement, they can be used in combination with other or even single preparations when the patient cannot tolerate them.
Physiotherapy and exercise programs are another very important treatment for these patients. Because Ankylosing Spondylitis is an inflammatory illness, and these people are more likely to develop osteoporosis than the general population, calcium, vitamin D, and other anti-inflammatory medicines are recommended -osteoporotic.

Is surgical intervention necessary?

Most people with Ankylosing Spondylitis do not need surgery. However, we can r surgery if the patient presents with joint damage and becomes disabled due to this injury.
The vast majority of persons with Ankylosing Spondylitis do not require surgery. However, if the patient has joint damage and becomes incapacitated as a result of this accident, we can recommend surgery.