Objectives: This study aims to examine the relationship of serum tumor necrosis factor-like weak inducer of apoptosis (sTWEAK) levels with
interleukin (IL)-6, tumor necrosis factor-alpha (TNF-α), fetuin-A, insulin, homeostatic model assessment (HOMA)-insulin resistance (IR), and disease
activity in patients with rheumatoid arthritis (RA) who are in remission or have low disease activity.
Patients and methods: Fifty-four patients with RA (8 males, 46 females; mean age 52.7±12.3 years; range 40 to 64 years) and 34 healthy controls (6
males, 28 females; mean age 53.2±11.3 years; range 41 to 65 years) were included in the study. The sTWEAK, fetuin-A, insulin, lipid profile and IL-6
concentrations were determined. The HOMA-IR levels were calculated using a calculator. Disease activity score 28 was used to assess the disease
activity.
Results: The erythrocyte sedimentation rate, C-reactive protein, fetuin-A, and IL-6 levels were higher in the RA group than in the control group
(p=0.004, 0.001, 0.001, and 0.003, respectively). sTWEAK levels were lower in the RA group than in the control group (p=0.007). There were no
differences in the TNF-α, HOMA-IR, insulin, and lipid profile levels of the two groups (p>0.05). sTWEAK had a negative correlation with body mass
index and fetuin-A (r=-0.261 and r=-0.287, respectively).
Conclusion: We found that RA patients had lower sTWEAK levels and higher fetuin-A levels than the control group subjects. Furthermore, these
two molecules were associated with each other. This study demonstrated that in RA patients, even if the disease is controlled with treatment,
some molecules associated with an increased metabolic and cardiovascular risk continue to function. Follow-up studies on larger populations are
warranted to confirm these findings.
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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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TİRAJE TUNCER , Erdal GİLGİL,
CAHİT KAÇAR , Yeşim KURTAİŞ,
ŞEHİM KUTLAY , Bülent BÜTÜN, Peyman YALÇIN,
ZEYNEP ÜLKÜ AKARIRMAK ,
LALE ALTAN İNCEOĞLU ,
FÜSUN ARDIÇ , Özge ARDIÇOĞLU,
ZÜHAL ALTAY , Ferhan CANTÜRK,
AYŞE BEYHAN LALE CERRAHOĞLU ,
REMZİ ÇEVİK ,
HÜSEYİN DEMİR ,
BERRİN DURMAZ ,
NİGAR DURSUN ,
MEHMET TUNCAY DURUÖZ , Canan ERDOĞAN, Deniz EVCİK,
SAVAŞ GÜRSOY ,
SAMİ HİZMETLİ , Ece KAPTANOĞLU, Önder KAYHAN,
MEHMET KIRNAP , Siranuş KOKİNO,
MUSTAFA ERKAN KOZANOĞLU ,
KADRİYE BANU KURAN ,
KEMAL NAS , Sema ÖNCEL,
DİLŞAD SİNDEL , Sevim ORKUN,
TUNAY SARPEL ,
SERPİL SAVAŞ ,
ÖMER FARUK ŞENDUR , Kazım ŞENEL,
HATİCE UĞURLU , Kaan UZUNCA,
İBRAHİM TEKEOĞLU , Francis GUILLEMIN
Objectives: This study aims to estimate the prevalence of rheumatoid arthritis (RA) and spondyloarthritis (SpA) in Turkey using the same telephone questionnaire developed for screening RA and SpA in France and used in Serbia and Lithuania. Material and methods: The study was performed in two steps. In step I, the French questionnaire was translated into Turkish and validated through a group of 200 patients (80 males, 120 females; mean age 44.0±13.1 years; range, 19 to 75 years) followed up at the rheumatology departments of University Hospitals in Antalya and Ankara. In step II, the validated Turkish questionnaire was administered face-to-face to randomly selected 4,012 subjects (1,670 males, 2,342 females; mean age 41.5±16.8 years; range, 16 to 97 years) by trained general practitioners across the country, in 25 provinces for case detection. The subjects who were suspected of having RA or SpA in accordance with the questionnaire were invited to the nearest university hospital for rheumatologic examination in order to confirm the diagnosis. Results: In step II, a total of 25 subjects (2 males, 23 females) were diagnosed as RA. The standardized RA prevalence for the general population of Turkey was calculated as 0.56% (95% confidence interval [CI]; 0.33-0.79), 0.10% (95% CI; -0.05-0.25) for males and 0.89% (95% CI; 0.51-1.27) for females. A total of 18 subjects (3 males, 15 females) were diagnosed as SpA. The standardized SpA prevalence for the general population of Turkey was 0.46% (95% CI; 0.25-0.67), 0.17% (95% CI; -0.03-0.37) for males and 0.65% (95% CI; 0.32-0.98) for females. The prevalence of RA was highest in the Northern region (2.00%) and the prevalence of SpA was highest in the Central region (1.49%). Conclusion: The prevalences of RA and SpA in Turkey are close to each other and there are significant inter-regional variations in prevalences of both RA and SpA.
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Objectives: This study aims to investigate the association of pentraxin 3 (PTX3) with neutrophil/lymphocyte ratio (NLR) rather than the disease activity score 28 using C-reactive protein in rheumatoid arthritis (RA). Patients and methods: The study included 59 RA patients (11 males, 48 females; mean age 53.79±13.55 years; range 40 to 66 years) and 20 healthy controls (5 males, 15 females; mean age 50.41±6.11 years; range 43 to 56 years). Complete blood count tests were recorded and NLR and platelet/lymphocyte ratio were calculated. PTX3 and interleukin-6 levels were examined in serum samples. Disease activity of RA patients was assessed by disease activity score 28. Results: Demographic characteristics were similar between the two groups, with no statistically significant difference in terms of sex, age, and body mass index (p>0.05). NLR, PTX3 and interleukin-6 levels were higher in patients with RA than the control group (p<0.05). While erythrocyte sedimentation rate had a positive correlation with mean platelet volume, we found no correlation between NLR and other parameters of disease activity, PTX3, and interleukin-6. Conclusion: We found no correlation between PTX3 and disease activity score 28 or NLR, although PTX3 levels were higher in RA patients than the controls. As a result, we were unable to establish a relationship between PTX3 and disease activity, directly or indirectly. To our knowledge, our study was the first to investigate the relationship between PTX3 and NLR.
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AMAÇ: Romatoid Artrit (RA), oryantasyon, dikkat ve
bellek zayıflığı gibi azalmış bilişsel işlevlere neden olur.
Sunulan bu çalışmanın amacı RA’da bilişsel işlevlerin bir
belirleyicisi olarak eklem yıkımını ve hastalığın diğer parametrelerini
değerlendirmektir.
GEREÇ VE YÖNTEM: Bu kesitsel çalışma, 45 hasta ve 40
sağlıklı kontrol içemektedir. RA’lı hastalarda radyolojik
progresyon skoru (≥0.5, modifiye Sharp / van der Heijde
skorları- MTS’ler), 28 eklemin hastalık aktivite skoru
(DAS-28) ve 44 eklemin hastalık aktivite skoru (DAS-44)
değerlendirildi. Mini Mental Test (MMSE) ve Hastane
Anksiyete Depresyon Ölçeği (HADÖ) değerlendirildi.
Sonuçlar, bilişsel işlevleri belirlemek için hasta ve kontrol
grubu arasında karşılaştırıldı.
BULGULAR: MMSE skorları açısından gruplar arasında
istatistiksel olarak anlamlı fark vardı (p=0.003). RA
ve kontrol grupları arasında anksiyete ve depresyon
düzeyleri açısından anlamlı farklılık yoktu. MMSE
skoru; hastalık süresi (p=0.011, r=-0.371), Sharp skoru
(p=0.018, r=-0.350) ve DAS-28(p=0.044, r=-0.296) skoru
ile ilişkilendirildi. Depresyon skoru da DAS ile ilişkiliydi
(p=0.004, r=0.425). Romatoid faktör düzeyleri, antisiklik
sitrullinat peptid düzeyleri ve bilişsel işlev testleri
arasında herhangi bir ilişki bulunamadı.
SONUÇ: Sonuçlar, uzun süredir RA olan hastalarda
inflamatuar mediatörlere maruz kalmanın, eklemleri
etkilediği sürece merkezi sinir sisteminde de bozulmaya
neden olabileceğini göstermektedir. Bilişsel bozulma,
hastalık şiddeti ve eklem yıkımı ile ilişkili idi. Dolayısıyla,
radyografik eklem hasarı, RA’daki bu kronik süreç boyunca
nöronal hasarın ve bilişsel bozulmanın boyutunu yansıtan
pozitif bir ön belirteç olabilir.
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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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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: Alt ekstremite amputasyonlu (AEA) hastalarda uyku kalitesini değerlendirmek ve uyku bozukluğu ile ilişkili faktörleri belirlemektir.Gereç ve Yöntemler: Bu çalışmaya AEA'lı 35 hasta ve 35 sağlıklı kontrol alındı. Çalışma grubunun demografik verileri kaydedildi. Uyku kalitesi Pittsburgh Uyku Kalitesi İndeksi (PUKİ) ile değerlendirildi. Amputasyonla ilişkili ağrı, Vizüel Analog Skala kullanılarak ölçüldü. Psikolojik durum Beck Depresyon Ölçeği (BDÖ) ve Beck Anksiyete Ölçeği (BAÖ) ile değerlendirildi.Bulgular: Hastalarda PUKİ'nin uyku süresi alt skoru dışında tüm alt skorları ve total skoru kontrol grubuna göre anlamlı olarak yüksekti. Total PUKİ skoru ile BDÖ (p<0,05) ve BAÖ (p<0,01) skoru korele idi. Multipl regresyon analizi ile yaş ve anksiyetenin uyku kalitesini belirlemede en önemli faktörler olduğu gösterildi (p<0,05). Sonuç: Çalışmamız kontrol grubuna göre AEA'lı hastalarının uyku kalitesinde bozulma olduğunu ve buna ek olarak yaş ve emosyonel durumun uyku kalitesiyle ilişkili olduğunu gösterdi. Bu nedenle ileri yaşta ve emosyonel durumu bozuk olan hastalarda çok yönlü tedavi yaklaşımları uyku bozukluğunu gidermek için gereklidir. Ancak uyku bozukluğunun nedenlerini ve genel sağlık üzerine etkilerini gösteren daha fazla hasta ile yapılmış ileri çalışmalara ihtiyaç vardır
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AJDA BAL HASTÜRK , Şebnem ATAMAN,
HATİCE BODUR , Aylin REZVANİ, Nurdan PAKER,
NURETTİN TAŞTEKİN ,
ALTINAY GÖKSEL KARATEPE ,
PINAR BORMAN , Mahmut YENER,
KEMAL NAS ,
MELEK SEZGİN , Pelin YAZGAN, İbrahim TEKEOĞLU,
BERİL DOĞU , Zuhal ALTAY,
MEHMET KIRNAP , Alev GÜRGAN,
ALİ GÜR ,
SAMİ HİZMETLİ ,
ZAFER GÜNENDİ , Rana ERDEM,
HATİCE UĞURLU , Elem İNAL, Neşe ÖLMEZ,
MUSTAFA ERKAN KOZANOĞLU , Öznur ÖKEN, Sumru ÖZEL, Ümit DÜNDAR, Ayşen AKINCI, Cihat ÖZTÜRK,
KAZIM ÇAPACI ,
KONÇUY SİVRİOĞLU ,
LALE ALTAN İNCEOĞLU ,
MEHMET TUNCAY DURUÖZ ,
İLKER YAĞCI , Ece AYDOĞ, Erhan ÇAPKIN, Deniz EVCİK, Oğuz DURMUŞ, Ömer Faruk ŞENDUR, Filiz Meryem SERTPOYRAZ, Ahmet ÖZGÜL, Kazım ŞENAL
Amaç: Bu çalışmanın amacı Türkiyedeki romatoid artrit hastalarının demografik ve klinik özelliklerini ortaya koyarak bu hastalar için oluşturulabilecek önlem, tedavi ve destek stratejilerine ışık tutmaktır. Hastalar ve yöntemler: Bu çalışma kapsamında Eylül 2007 - Mart 2011 tarihleri arasında Türkiyenin farklı bölgelerindeki toplam 36 merkezden Türkiye Romatizma Araştırma ve Savaş Derneği (TRASD) kayıt sistemine kaydedilen 2.359 hasta (1.966 kadın, 393 erkek; ort. yaş 51.6±12.5 yıl; dağılım 18-75 yıl) değerlendirildi. Hastaların demografik ve klinik verileri kaydedildi. Hastalık aktivitesi, fonksiyonel durum ve radyografik hasar sırasıyla hastalık aktivite skoru 28, sağlık değerlendirme anketi ve van der Heijde modifiye Sharp puanlama yöntemi ile ölçüldü. Bulgular: Akademik eğitim süresi ortalama 5.2±3.8 yıldı ve hastaların %74.6sı ev hanımıydı. Hastaların %91.0ı biyolojik olmayan hastalık modifiye edici ilaçlar, %10.2si biyolojik hastalık modifiye edici ilaçlar kullanıyordu. Ortalama hastalık aktivite skoru 28, sağlık değerlendirme anketi ve Sharp puanları sırasıyla, 4.0±1.4, 0.38±0.37 ve 31.2±57.1 idi. Hastaların %17.8i remisyonda ve %14.1i düşük hastalık aktivitesinde iken %42.7si orta hastalık aktivitesinde ve %25.5i yüksek hastalık aktivitesinde idi. Sonuç: Türkiyede romatoid artrit hastalarının çoğunluğu orta yaşlı ev hanımlarıdır. Her ne kadar hastalık modifiye edici ilaç kullanımı yüksek oranda ise de hastaların büyük bölümü orta ve yüksek hastalık aktivite düzeyinde idi. Bu bulgular romatoid artritli hastaların tedavi gereksinimlerinin yeterli olarak karşılanmadığını düşündürmektedir.
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