Objectives: This study aims to examine the relationship of serum tumor necrosis factor-like weak inducer of apoptosis (sTWEAK) levels withinterleukin (IL)-6, tumor necrosis factor-alpha (TNF-α), fetuin-A, insulin, homeostatic model assessment (HOMA)-insulin resistance (IR), and diseaseactivity 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 (6males, 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-6concentrations were determined. The HOMA-IR levels were calculated using a calculator. Disease activity score 28 was used to assess the diseaseactivity.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 nodifferences 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 massindex 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, thesetwo 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 arewarranted 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 vebellek zayıflığı gibi azalmış bilişsel işlevlere neden olur.Sunulan bu çalışmanın amacı RA’da bilişsel işlevlerin birbelirleyicisi olarak eklem yıkımını ve hastalığın diğer parametrelerinideğerlendirmektir.GEREÇ VE YÖNTEM: Bu kesitsel çalışma, 45 hasta ve 40sağlıklı kontrol içemektedir. RA’lı hastalarda radyolojikprogresyon skoru (≥0.5, modifiye Sharp / van der Heijdeskorları- MTS’ler), 28 eklemin hastalık aktivite skoru(DAS-28) ve 44 eklemin hastalık aktivite skoru (DAS-44)değerlendirildi. Mini Mental Test (MMSE) ve HastaneAnksiyete Depresyon Ölçeği (HADÖ) değerlendirildi.Sonuçlar, bilişsel işlevleri belirlemek için hasta ve kontrolgrubu arasında karşılaştırıldı.BULGULAR: MMSE skorları açısından gruplar arasındaistatistiksel olarak anlamlı fark vardı (p=0.003). RAve kontrol grupları arasında anksiyete ve depresyondüzeyleri açısından anlamlı farklılık yoktu. MMSEskoru; 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) skoruile ilişkilendirildi. Depresyon skoru da DAS ile ilişkiliydi(p=0.004, r=0.425). Romatoid faktör düzeyleri, antisikliksitrullinat peptid düzeyleri ve bilişsel işlev testleriarasında herhangi bir ilişki bulunamadı.SONUÇ: Sonuçlar, uzun süredir RA olan hastalardainflamatuar mediatörlere maruz kalmanın, eklemlerietkilediği sürece merkezi sinir sisteminde de bozulmayaneden olabileceğini göstermektedir. Bilişsel bozulma,hastalık şiddeti ve eklem yıkımı ile ilişkili idi. Dolayısıyla,radyografik eklem hasarı, RA’daki bu kronik süreç boyuncanöronal hasarın ve bilişsel bozulmanın boyutunu yansıtanpozitif 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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Amaç: Bu çalışmanın amacı inmeli hastaların global ve spesifik alanlarda yaşam kalitesini değerlendirmek ve inme sonrası yaşam kalitesini etkileyen değişkenleri belirlemektir. Gereç ve Yöntemler: Serebrovasküler olaya bağlı hemiplejisi olan, kognitif fonksiyonları yeterli 104 hasta ve 108 sağlıklı kontrol çalışmaya alındı. Demografik ve klinik özellikler kaydedildi. Hastaların fonksiyonel durumlarını değerlendirmek için Barthel İndeksi (Bİ) ve Fonksiyonel Ambulasyon Sınıflaması kullanıldı. Yaşam kalitesi Kısa form 36 (SF-36) sağlık değerlendirme anketi ile, emosyonel durumları Hastane Anksiyete ve Depresyon Ölçeği (HADÖ) ile değerlendirildi. Fonksiyonel durum, motor bozukluk ve emosyonel durum bağımsız değişkenler olarak belirlendi ve yaşam kalitesini tahmin etmek için kullanıldı. Bulgular: Hastaların total ve subtotal SF-36 skorları kontrol grubuna göre anlamlı düşüktü (p<0,001). Ortalama anksiyete ve depresyon skorları kontrol grubuna göre hasta grubunda yüksekti (p<0,001). Bazı subskorlar ve SF-36nın fiziksel komponent skoru kadın ve okumamış hastalarda erkek hastalar ve okumuşlara göre anlamlı düşüktü. Multipl regresyon analizine göre, depresyon düzeyi mental sağlık ile (p<0,001); sakatlık düzeyi fiziksel sağlık ile ilişkiliydi (p<0,05). Bu çalışmanın gücü verilen örneklem hacmine göre %100dür (α=0,01). Sonuç: Bu çalışma genel popülasyona göre inme hastalarının önemli derecede kötü yaşam kalitesine sahip olduğunu gösterdi. İnme sonrası yaşam kalitesindeki bozulma, cinsiyet ve eğitim düzeyi gibi demografik özellikler, fiziksel disabilite ve emosyonel durum ile ilişkili görünmektedir. Bu nedenle disabilitenin engellenmesi, depresyonun erken tanı ve tedavisi, inme hastalarının yaşam kalitesini arttırmada önemlidir.
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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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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
Objectives: This study aims to report Turkish League Against Rheumatism s assessment on the compliance of European League Against Rheumatism 2013 treatment recommendations for rheumatoid arthritis with practices in Turkish rheumatology clinics and adaptations for Turkey. Patients and methods: Members of Turkish League Against Rheumatism and one rheumatoid arthritis patient voted for the 2013 recommendations of the European League Against Rheumatism for treatment of rheumatoid arthritis in two sessions. An item was changed and voted again only if at least 70% of participants wanted a change. Strength of recommendations was calculated for the items. Strength of recommendations for the changed items in the first and second voting rounds was compared by Wilcoxon signed-rank test. In case of significant difference, the item with higher strength of recommendation was accepted. In case of no difference, the changed item was selected. Results: Three overarching principles and fourteen recommendations were assessed among which the three overarching principles were changed emphasizing the importance of physiatrists as well as rheumatologists for taking care of the patients. Third item was changed by adding composite indices for assessing disease activity. In the ninth recommendation, rituximab was suggested as a first line drug independent of situations like latent tuberculosis or lymphoma, etc. In the 11th recommendation, unlike European League Against Rheumatism, our committee did not suggest any thought about tofacitinib, as then it had not been approved in Turkey. Remaining principles were accepted as the same. Conclusion: Expert opinion of Turkish League Against Rheumatism for treatment of rheumatoid arthritis patients was formed for practices in Turkish clinics. Conflict of Interest The authors declared no conflicts of interest with respect to the authorship and/or publication of this article. Financial Disclosure The authors received no financial support for the research and/or authorship of this article.
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