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Ankylosing Spondylitis

Medical information reviewed by: ALIZZI KHALID, MD, Rheumatologist

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What awaits you at Centrokinetic?

Centrokinetic welcomes patients, having a complete rheumatology department, a medical branch that deals with the diagnosis, treatment, and recovery of patients with non-surgical musculoskeletal disorders. These conditions are usually painful, acute, or, most often, chronic, preventing the proper functioning of the musculoskeletal system. They are generally called rheumatism or rheumatic and musculoskeletal diseases.

Most of the times, the patient's evaluation is complex, multidisciplinary, considering the systemic, generalized character of most rheumatological diseases, that is why Centrokinetic has experienced doctors:

What is spondylitis?

Spondylitis, sometimes called "spondyloarthritis" is a form of arthritis that frequently occurs in the spine, although it can affect other joints. The name "spondylitis" itself is associated with a family of diseases and conditions that are similar in progress and their symptoms but can affect different regions of the body. When spondylitis develops in the spine, it becomes highly inflamed. Pain and other symptoms often result. Sometimes the vertebral bones fuse, forming a very rigid section and causing limited mobility.

Statistically, men are more likely to develop spondylitis than women. Symptoms usually begin to appear in adulthood, with loss of spinal flexibility and a hunched posture being two of the most prominent signs. Spondylitis is treatable when properly diagnosed and approached proactively. Without proper care, spondylitis develops into a chronic, painful condition.

Spondylitis is often confused with mechanical back pain, which usually occurs after a real injury to the spine. In contrast, spondylitis involves inflammation in the vertebral joints and usually does not result from a single definitive incident. Patients with spondylitis often show:
  • Pain and stiffness anywhere from the neck to the lower back and buttocks, lasting more than three months
  • Discomfort, which is worse in the morning or after long periods of inactivity and seems to diminish with exercise
  • A progressive loss of flexibility of the spine and a feeling of stiffness
  • Inclined posture
  • tendinitis
  • Bone growth commonly referred to as bone fusion, which can affect daily activities
  • Vision problems and eye inflammation, including redness and pain
  • Compression fractures

As spondylitis matures, it can begin to affect more regions of the body. The connections between the vertebrae in the spine and the pelvis are vulnerable to spondylitis, as well as the hip and shoulder joints. Even places where ligaments and tendons attach to the spinal bones can become affected by spondylitis.

Ankylosing spondylitis is the most common and severe subtype of spondyloarthritis. It primarily affects the axial joints, especially the sacroiliac joints. Other locations involved are the spine, peripheral joints, capsules, ligaments, and tendons. Over time, pain and stiffness can progress to the upper spine and even the rib cage and neck. Finally, inflammation can cause sacroiliac and vertebral bones to join or grow together. When the bones become fixed, the spine loses its normal flexibility and becomes rigid. The chest can also fuse, which can limit its normal expansion and make breathing difficult. Inflammation and pain can also occur in the hips, shoulders, knees, ankles, fingers, which can limit mobility.

To diagnose spondylitis, our doctors rely on medical history, physical examination of the joints and spine, imaging tests of the pelvis, and also blood tests to verify the HLA-B27 gene. The existence of the HLA-B27 gene does not determine the presence of spondylitis, but it is an indication that may support the diagnosis. Many people have the HLA-B27 gene and do not have spondylitis. General health and family medical history is important because ankylosing spondylitis can be hereditary. Ankylosing spondylitis may or may not be associated with non-skeletal diseases such as uveitis (inflammation of the eye), prostatitis (inflammation of the prostate), and certain conditions that affect heart and lung function. A blood test will reveal HLA-BA27 antigen. The physical exam often includes the following:

Schober test: Limited movement of the lumbar spine is a symptom of spondylitis. The Schober test measures the degree of lumbar flexion in the direction in which the patient bends as if touching the toes. The progressive loss of spinal movement is correlated with the radiographs findings.

Gaenslen test: Sacroiliac pain often occurs in the early stages of spondylitis. Gaenslen's maneuver emphasizes the sacroiliac joints. Increased pain during this maneuver may indicate joint disease.

A blood test indicated by our doctors can sometimes show if there is inflammation in the body. It may be necessary to perform one or more of these tests:

  • C-reactive protein
  • erythrocyte sedimentation rate
  • plasma viscosity

Our medical team will come in addition to the investigations to establish a correct diagnosis, with imaging investigations (musculoskeletal ultrasound, joint MRI), functional tests (electromyography), arthrocentesis. Discover the open MRI imaging center in our clinic. Centrokinetic has a state-of-the-art MRI machine, dedicated to musculoskeletal conditions, in the upper and lower limbs. The MRI machine is open so that people suffering from claustrophobia can do this investigation. The examination duration is, on average, 20 minutes.

Treatment

The goal of treatment is to eliminate pain and stiffness and to prevent or delay complications and deformity of the spine. Treatment for spondylitis is most successful before the disease causes irreversible joint damage. Numerous treatments are available that can relieve pain and stiffness, but exercise and specific attention to your posture are just as important in keeping your spine mobile and helping you live a normal life.

A common treatment regimen for various forms of spondylosis involves medication, exercise, physical therapy, posture practices, and other options such as cold/warm therapy to relax your muscles and reduce joint pain. In severe cases, posture correction surgery may be an option.

At Centrokinetic, our doctors can investigate, diagnose, and treat you to get the best results. They can also perform joint and periarticular injections with:  

  • Anti-inflammatory solutions or corticosteroids:  are usually used for several types of musculoskeletal problems, such as tendinitis, tenosynovitis, bursitis, fasciitis, osteoarthritis, muscle injuries, ligament injuries. Corticosteroids are natural hormones made from cholesterol in the adrenal glands. In clinical practice, steroids are used for their powerful anti-inflammatory effects. Corticosteroids should not be confused with anabolic steroids, which are known to be used by athletes to increase muscle mass and strength. Corticosteroids used in resentment are injected all over the world, the administration doses are minimal, on average 0.4mg, and the side effects are similar in elderly patients, by temporarily increasing (2-3 days) blood pressure and blood sugar.
  • Sterile viscoelastic solutions (hyaluronic acid): are performed mainly intraarticularly, both in the large joints (knee, shoulder, hip, ankle) and in the small ones (fist, elbow, metatarsophalangeal, or interphalangeal). The role of these infiltrations is multiple: protector of the articular cartilage through the viscous properties of the injection - the molecules of Hyaluronic Acid in the synovial fluid, act as a lubricant, protecting the articular surfaces from mechanical damage, by elastic properties - under the pressure generated by the joint load (bodyweight), hyaluronic acid in a synovial fluid acts as a shock absorber, protecting cartilage from compressive trauma, a nutrient for joint cartilage, synovial tissue protector:  Hyaluronic acid is a protective barrier for the synovial membrane and masks the receptors for inflammation in the knee, reducing inflammation.
  • Infiltrations with PRP (platelet hyperconcentrate): have been used since 1978 in the USA, in the treatment of musculoskeletal disorders, with extraordinary results. The infiltration lasts on average 40 minutes, is painless, and consists of collecting peripheral blood (from the vein) of the patient, on average between 60 and 180 ml, centrifugation 20-25 minutes to separate platelets from other blood cells, and injection into the same stage in the affected area. Centrokinetic offers patients treatments with the best PRP kits in the world, brought from the USA, from Arthrex and Magellan. The rationale for using this type of infiltration is to initiate and accelerate the natural process of tissue healing and regeneration by releasing platelet-derived growth factors directly into the affected tissue. According to current studies, soft tissue lesions and cartilage lesions are receptive to this treatment. Some of these include the following: tendinitis (epicondylitis, plantar tendonitis, Achilles, patellar, etc.), tendinosis, tendon ruptures, tendon degenerative lesions, muscle ruptures, cartilage lesions (arthrosis). The therapy also has a postoperative indication in meniscus suture, ligamentoplasty, sutures/tendon reinsertions (rotator cuff, Bankard, Achilles tendon, patellar tendon, quadrigeminal, etc.).
  • Autologous growth factor therapy:  is a therapy used in Germany for 15 years, and consists of harvesting the body's growth factors, multiplying them by incubation, and reinjecting them into the affected area. The duration of the treatment is 3 hours, performing 3-5 procedures, at 1-week intervals. The major indications are chronic tendinitis (epicondylitis, plantar tendonitis, Achilles, patellar), and articular cartilage lesions (arthrosis). It also has excellent results in the treatment of joint and periarticular pain.  Autologous growth factor therapy is a treatment with a cytokine-rich autologous serum (ACRS), derived from the patient's blood. To ensure high tolerability, this technology completely avoids the use of any artificial additives. This special serum, rich in autologous cytokines, can activate the body's ability to heal itself by producing positive interleukins and growth factors. These are crucial to intervene in the cascade of pain, causing it to stop and the subsequent onset of the healing process.

Centrokinetic clinic has a very experienced team, specialized in sports traumatology, accredited in: Tecar therapy, dynamic taping, massage, Graston technique, Kinesio Tape, ERGON, flossing band. Our team has attended numerous overspecialized courses with trainers from the country and abroad, being certified to perform therapies at the highest level. The experience gained in recent years has meant recovering over 250 patients per month.

About Centrokinetic

Centrokinetic clinic offers all services necessary for a complete rehabilitation process, from the first consultation to the medical specialist to establish the correct diagnosis, to treatment and recovery.

Centrokinetic is the place where you will find clear answers and solutions for your motricity problems. The clinic is dedicated to osteoarticular conditions and is divided into the following departments:

  • Orthopedics, a department composed of an extremely experienced team of orthopedic doctors, led by Dr. Andrei Ioan Bogdan, primary care physician in orthopedics-traumatology, with surgical activity at Medlife Orthopedic Hospital, specialized in sports traumatology and ankle and foot surgery.
  • Pediatric orthopedics, where children's sports conditions are treated (ligament and meniscus injuries), spinal deformities (scoliosis, kyphosis, hyperlordosis) and those of the feet (hallux valgus, hallux rigidus, equine larynx, flat valgus, hollow foot).
  • Neurology, which has an ultra-performing department, where consultations, electroencephalograms (EEG) and electromyography (EMG) are performed. 
  • Medical recovery  for adults and  children, department specialized in the recovery of performance athletes, in spinal disorders, in the recovery of children with neurological and traumatic diseases. Our experience is extremely rich, treating over 5000 performance athletes.
  • Medical imaging, the clinic being equipped with ultrasound and MRI, high-performance devices dedicated to musculoskeletal disorders, and complemented by an experienced team of radiologists: Dr. Sorin Ghiea and Dr. Cosmin Pantu, specialized in musculoskeletal imaging.

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