ŞEBNEM ATAMAN , İsmihan SUNAR, Gürkan YILMAZ,
HATİCE BODUR ,
KEMAL NAS , Fikriye Figen AYHAN,
ÖZGÜR AKGÜL ,
AYŞEN AKINCI ,
ZÜHAL ALTAY ,
MURAT BİRTANE , Derya SOY BUĞDAYCI, Erhan ÇAPKIN,
REMZİ ÇEVİK , Yeşim Garip ÇİMEN, M. Tuncay DURUÖZ,
ATİLLA HALİL ELHAN ,
GÜLCAN GÜRER ,
CAHİT KAÇAR ,
AYHAN KAMANLI , Ece KAPTANOĞLU, Taciser KAYA, Hilal KOCABAŞ,
ÖMER KURU ,
MELTEM ALKAN MELİKOĞLU , Sumru ÖZEL,
AYLİN REZVANİ ,
İLHAN SEZER , Fatma GÜL YURDAKUL
Objectives: This study aims to report the assessment of the Turkish League Against Rheumatism (TLAR) expert panel on the compliance and adaptation of the European League Against Rheumatism (EULAR) 2016 recommendations for the management of rheumatoid arthritis (RA) in Turkey. Patients and methods: The EULAR 2016 recommendations for the treatment of RA were voted by 27 specialists experienced in this field with regard to participation rate for each recommendation and significance of items. Afterwards, each recommendation was brought forward for discussion and any alteration gaining ≥70% approval was accepted. Also, Turkish version of each item was rearranged. Last version of the recommendations was then revoted to determine the level of agreement. Levels of agreement of the two voting rounds were compared with Wilcoxon signed-rank test. In case of significant difference, the item with higher level of agreement was accepted. In case of no difference, the changed item was selected.Results: Four overarching principles and 12 recommendations were assessed among which three overarching principles and one recommendation were changed. The changed overarching principles emphasized the importance of physical medicine and rehabilitation specialists as well as rheumatologists for the care of RA patients in Turkey. An alteration was made in the eighth recommendation on treatment of active RA patients with unfavorable prognostic indicators after failure of three conventional disease modifying anti-rheumatic drugs. Remaining principles were accepted as the same although some alterations were suggested but could not find adequate support to reach significance. Conclusion: Expert opinion of the TLAR for the treatment of RA was composed for practices in Turkish rheumatology and/or physical medicine and rehabilitation clinics.
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HATİCE BODUR , Fatma GÜL YURDAKUL,
ŞEBNEM ATAMAN , Yeşim GARİP,
KEMAL NAS , Fikriye Figen AYHAN,
ÖZGÜR AKGÜL ,
AYŞEN AKINCI ,
ZÜHAL ALTAY ,
MURAT BİRTANE , Derya SOY BUĞDAYCI, Erhan ÇAPKIN,
REMZİ ÇEVİK ,
MEHMET TUNCAY DURUÖZ ,
GÜLCAN GÜRER ,
CAHİT KAÇAR ,
AYHAN KAMANLI , Taciser KAYA, Hilal KOCABAŞ,
ÖMER KURU , Ece KAPTANOĞLU,
MELTEM ALKAN MELİKOĞLU , Erhan ÖZDEMİREL, Sumru ÖZEL,
AYLİN REZVANİ ,
İLHAN SEZER , İsmihan SUNAR,
TUFAN GÜRKAN YILMAZ
Objectives: This study aims to update 2011 Turkish League Against Rheumatism SpondyloArthritis Recommendations, and to compose a national expert opinion on management of axial spondyloarthritis under guidance of current guidelines, and implantation and dissemination of these international guidelines into our clinical practice. Materials and methods: A scientific committee of 28 experts consisting of 14 rheumatologists and 14 physical medicine and rehabilitation specialists (one of them also has an immunology PhD) was formed. The recommendations, systematic reviews, and meta-analyses including pharmacologic and non-pharmacologic treatment were scrutinized paying special attention with convenient key words. The draft of Turkish League Against Rheumatism opinion whose roof consisted of international treatment recommendations, particularly the Assessment of SpondyloArthritis International Society/European League Against Rheumatism recommendations was composed. Assessment of level of agreement with opinions by task force members was established through the Delphi technique. Voting using a numerical rating scale assessed the strength of each recommendation. Results: Panel compromised on five basic principles and 13 recommendations including pharmacological and nonpharmacological methods. All of the recommendations had adequate strength. Conclusion: Turkish League Against Rheumatism expert opinion for the management of axial spondyloArthritis was developed based on scientific evidence. These recommendations will be updated regularly in accordance with current developments.
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İskiofemoral impingement sendromu genellikle iskium ve femur arasında sıkışmaya bağlı kalça ağrısı nedenlerinden biridir. Bugüne kadar olan vakalarda kalça ağrısı ile kuadratus femoris manyetik rezonans görüntüsünde iskiofemoral aralığın daralması arasında bir ilişki olduğu bildirilmiştir. Travma veya cerrahi olsun olmasın orta yaşlı kadınlarda impingement sendromu görülebilir. Biz bu vakamızda kalça ağrısı nedeniyle periferik spondilartropati tanısı alan fakat tedaviye rağmen şikayetleri gerilemeyen, sonrasında iskiofemoral impingement sendromu tanısı alan bir olguyu sunduk.
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KEMAL NAS , Erkan KILIÇ,
REMZİ ÇEVİK ,
HATİCE BODUR ,
ŞEBNEM ATAMAN , Figen AYHAN,
ÖZGÜR AKGÜL ,
AYŞEN AKINCI ,
ZÜHAL ALTAY ,
ERHAN ÇAPKIN , Abdullah Zübeyir DAĞLI,
MEHMET TUNCAY DURUÖZ ,
GÜLCAN GÜRER ,
FERİDE NUR GÖĞÜŞ , Yeşim GARİP,
CAHİT KAÇAR ,
AYHAN KAMANLI , Ece KAPTANOĞLU, Taciser KAYA, Hilal KOCABAŞ, Erhan Ali ÖZDEMİREL, Sumru ÖZEL,
İLHAN SEZER , İsmihan SUNAR, Gürkan YILMAZ
Objectives: This study aims to establish the first national treatment recommendations by the Turkish League Against Rheumatism (TLAR) for psoriatic arthritis (PsA) based on the current evidence. Materials and methods: A systematic literature review was performed regarding the management of PsA. The TLAR expert committee consisted of 13 rheumatologists and 12 physical medicine and rehabilitation specialists experienced in the treatment and care of patients with PsA from 22 centers. The TLAR recommendations were built on those of European League Against Rheumatism (EULAR) 2015. Levels of evidence and agreement were determined. Results: Recommendations included five overarching principles and 13 recommendations covering therapies for PsA, particularly focusing on musculoskeletal involvement. Level of agreement was greater than eight for each item. Conclusion: This is the first paper that summarizes the recommendations of TLAR as regards the treatment of PsA. We believe that this paper provides Turkish physicians dealing with PsA patients a practical guide in their routine clinical practice.
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ŞEBNEM ATAMAN , Zühre SÜRMELİ SARI, İsmihan SUNAR, Erhan ÖZDEMİREL, Ayşen AKINCI, Hatice BODUR,
ÖZGÜR AKGÜL ,
LALE ALTAN İNCEOĞLU , Zuhal ALTAY, Figen AYHAN,
MURAT BİRTANE , Derya BUĞDAYCI SOY, Erhan ÇAPKIN,
AYŞE BEYHAN LALE CERRAHOĞLU ,
MEHMET TUNCAY DURUÖZ , Rezzan GÜNAYDIN,
ZAFER GÜNENDİ , Gülcan GÜRER,
AJDA BAL HASTÜRK , Cahit KAÇAR, Ece KAPTANOĞLU, Taciser KAYA, Hilal KOCABAŞ, Nurdan KOTEVOĞLU,
KEMAL NAS , Aylin REZVANİ, Nesrin ŞEN,
ÖMER FARUK ŞENDUR , Peyman YALÇIN
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Amaç: Bu çalışmada Türkiye'de romatizmal hastalıkların tedavisinde kullanılan biyolojik ajanlara bağlı gelişen bildirilmiş yan etkiler derlendi.Hastalar ve yöntemler: Ocak 2000 ile Ocak 2012 tarihleri arasında romatizmal hastalıkların tedavisinde kullanılan infliksimab, etanersept, adalimumab, anakinra, rituksimab dahil olmak üzere biyolojik ajanlara bağlı gelişen yan etkileri bildiren olgu ve olgu serileri MedLine, Web of Science ve Scopus veri tabanları kullanılarak İngilizce ve Türkçe dillerinde tarandı.Bulgular: Literatürde Türkiye'den biyolojik ajana bağlı yan etki görülen romatizmal hastalıklı toplam 53 olgu (21 erkek, 32 kadın) bildirilmiştir. Yaş ortalaması 39.0±15.6 yıl ve ortalama hastalık süresi 10.6±8.2 yıl idi. Biyolojik ajanlara başlanması ile yan etkinin ortaya çıkması arasındaki geçen süre ortalama 8.8±9.2 aydı. Biyolojik ajan kullanımına bağlı olarak en sık görülen yan etki ankilozan spondilit (AS) ve romatoid artrit (RA) hastalarında gözlendi. En sık bildirilen yan etki 14 hastada (%26.4) tüberküloz idi. Diğer yan etkiler psöriyazis (%15.1), solid tümör (%7.6), lenfoma (%5.7), ilaca bağlı lupus (%3.8) ve menstrüel kanama (%3.8) idi. Yan etki gelişen olguların toplam %77.4'ünde biyolojik tedaviler sonlandırıldı.Sonuç: Biyolojik ajanlar nispeten güvenli olmakla beraber, nadiren ciddi yan etkilere neden olabilir. Türkiye'de tüberküloz orta derecede endemik bir hastalık olması nedeniyle, biyolojik ajan tedavisi (özellikle anti-TNF ve abatasept) planlanan hastalar tedavi öncesinde ve tedaviye başladıktan sonra tedavinin olası riskleri açısından bilgilendirilmeli ve yakından takip edilmelidir
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