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.