General Clinic

Rheumatology

 

The Rheumatology Service at Hygeia Hospital Tirana offers specialized treatment for all the rheumatic diseases, such as:

  • Inflammatory arthritis (Rheumatoid Arthritis, Psoriatic Arthritis, Inflammatory Spondilarthropathy etc.).
  • Degenerative arthritis (osteoarthritis, lumbar pain).
  • Systemic connective tissue diseases, and vasculitis (Systemic Lupus Erythematosus, Sjögren's Syndrome, Necrotizing Vasculitis Wegener and other forms of vasculitis).
  • Metabolic bone diseases (osteoporosis, Morbus Paget).
  • Rheumatic diseases of the soft tissues (Periarthritis, Tendonitis, Fibromyalgia and Chronic Fatigue Syndrome).
  • Neuropathies such as Carpal Tunnel Syndrome.
  • Autoinflammatory disease (Still's Disease in adults, Mediterranean Family Fever, etc.).

At the Rheumatology Service at Hygeia Hospital Hygeia Tirana , the use of sophisticated laboratory and imaging techniques enables a quick diagnosis of rheumatic diseases accurately. Regarding this aspect, the following are also very important:

  • Hematological and biochemical examinations.
  • Immunological examinations that help us have a complete assessment of the patient's immunological profile.
  • The most modern imaging techniques ranging from a simple radiography or a digital one , continuing with CT scanners, Magnetic Resonance Imaging MRI, PET-CT, bone density measurement, musculoskeletal ultrasounds etc.
  • Electrophysiological assessment (electromyography)
  • Collaboration with other specialties to obtain biopsies and hystopathological assessment of the affected organs in the cases of rheumatic multi-organ systemic inflammatory diseases.

Structure

 

The Rheumatology Service at Hygeia Hospital Tirana is structured in order to provide a full service assessment and treatment for rheumatic diseases through:

  • The Outpatient Department in which all patients who come to the hospital are being admitted for a visit to the rheumatologist.
  • The Daily Service in which there are mainly hospitalized patients who do not need extended stay in the hospital but who need to stay for some time when medical treatment is required in the dynamic tracking for several hours by the medical and nursing staff, ex. medications administration intravenously (biological medications, medications for osteoporosis, etc.).
  • The Inpatient Department in which there are hospitalized patients who need a careful service and a full treatment to stabilize their health condition.

The doctors of the Rheumatology Department at Hygeia Hospital, except for working in this service, they also offer consultations to help the diagnosis of patients admitted in other services of the hospital and who may have presented elements of rheumatic diseases.

Treatment

 

The treatment of patients in the Rheumatology Department of Hygeia Hospital Tirana is conducted relying on the data from the full assessment of the patient, the clinic and laboratory assessment, which allows us to make the right selection of the appropriate treatment for each patient. Before starting with a treatment, the rheumatologist discusses with the patient on the treatment scheme, explaining the application of this scheme to achieve the desired medical results. For the treatment of rheumatic diseases in our service we use medications as sole (monotherapy) or combined between them (pluritherapy) depending on the stage of the disease and aiming always to achieve a significant improvement in the health status of the patient. Among the major groups of medications used for the treatment of rheumatic diseases there are:

  • The analgesic drugs that help ease the pain and reinforce the effect of other drugs in cases of schemes of treatment with more than one drug.
  • The Non-inflammatory drugs, not steroids (NSAIDs) that significantly reduce the pain and swelling. The effect of non-steroid anti-inflammatory begins within a short period of time from the moment you take and it lasts for several hours, so patients are recommended to use them in the regular way. There are about 20 different forms of anti-inflammatory drugs, not steroids such as Ibuprofen, Diclofenac, Indomethacin, Nimesulide, Naproxen, etc.
  • Glucocorticoids (cortisone) which are very effective in reducing inflammation. Although they do not fully treat the disease, glucocorticoids are able to inhibit the development of the disease by relieving the clinical symptoms in patients with rheumatic diseases. These drugs exist in the form of tablets and capsules which can be taken orally but also in liquid form to be taken as intravenous injections, intramuscular or intra-articular injections. There are several forms of glucocorticoids such as Prednisone, Prednisolone, Metilprednisolon, Dexametason etc.
  • Disease modifying rheumatic drugs (DMARDs) are drugs that "fight" the disease and not the symptoms of it. These drugs do not effect immediately as analgesics or NSAIDs (non-steroid anti-inflammatory) do, but they need a little time to calm the activity of the disease. These medications are classified into two categories: traditional and biological. In traditional drugs, the most used ones are: Methotrexate, Hydroxychloroquine and Sulfasalazine while there is also used a subcategory of these drugs known as imunosupresors such as Azathioprine, Leflunomide, Cyclosporine. These medications inhibit the exaggeration of the activity of the immune system and they are used for a period of time while monitoring the activity of the disease with your physician. In this way it becomes possible to reduce the dose of the medications gradually according to the reduction of the activity of the disease. In case the disease modifying traditional medicines do not provide the expected effect then you should start therapy with biological drugs. The biological drugs are fight molecules and / or specific proteins involved in inflammations and in demining of organs. These drugs have been significantly used in the treatment of rheumatic diseases in the past 10-15 years. The most used biological drugs: Adalimumab, Etanercept, Infliximab, Rituximab, Tocilizumab, Abatacept, Certolizumab etc.
  • Medications against osteoporosis are the following ones calcium and vitamin D, Bisphosphonates (Alendronate, Risedonate, Ibandronate, etc.), teriparatide, raloxifen, denosumab, hormone replacement therapy, etc.

All drugs have side effects, so it is suggested to use them carefully. The initiation of a therapy should happen only after full assessment of the health status of the patient by the physician. For example the doctor can add Calcium and Vitamin D in the therapy of patients who require treatment for some time with glucocorticoids in such a way as to minimize their effect on the reduction of bone density or he may add a protective gastric mucosa in the case of the use of non-steroid anti-inflammatory drugs etc.

The treatment of patients with rheumatic diseases in the Rheumatology Service of Hygeia Hospital Tirana, is based not only on the use of drugs but also in a number of other elements necessary to achieve an improvement in the health status of the patient. Regarding this there are some important things which should be mentioned:

  • The patients’ education about the basic disease. The patient is explained in a comprehensible manner, as far as it concerns this basic disease, factors that can worsen or improve it; their medications, their use and the possible side effects that they might have; the importance of a proper food diet; smoking cessation which is one of the main factors for the apparition of rheumatic diseases etc. All these measures aim the patient to learn to coexist with the disease by minimally limiting common vital activities.
  • The continuous monitoring of patients in order to control not only the possible side effects of the therapy but also the benefits of the treatment plan. The Rheumatology Service of Hospital Hygeia Tirana keeps records of each patient in an electronic system (SAP) so we can assess the situation periodically.
  • The rehabilitation of patients in cooperation with the Physiotherapy Service suggesting the proper exercises to relieve symptoms, improve the degree of motion and strengthening of bones and maintaining muscular strength.
  • The management of complications in patients with rheumatic diseases in collaboration with other medical services at Hygeia Hospital Tirana (Dermatology, Neurology, Nephrology, Infectious Disease, Orthopedics, etc.).

The Service of Rheumatology at Hygeia Hospital Tirana has increased its participation in activities of research and continuous education in our country and abroad bringing this way the most contemporary treatment of patients with rheumatic diseases.

Personnel


Rheumatologist
DHAMO BLERINA


© 2009 HYGEIA Hospital Tirana