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Öğe Description of the registry of patients with ankylosing spondylitis in Turkey: TRASD-IP(Springer Heidelberg, 2012) Bodur, Hatice; Ataman, Sebnem; Bugdayci, Derya Soy; Rezvani, Aylin; Nas, Kemal; Uzunca, Kaan; Emlakcioglu, EmelA web-based application patient follow-up program was developed to create a registry of patients with ankylosing spondylitis (AS) by the Turkiye Romatizma Arastirma Savas Dernegi (TRASD) AS Study Group. This study describes the methodological background and patient characteristics. The patient follow-up program is a web-based questionnaire, which contains sections on socio-demographic data, anamnesis, personal and family history, systemic and musculoskeletal examination, laboratory and imaging data and treatment. Between October 1, 2007 and February 28, 2009, 1,381 patients from 41 centers were included in the registry (1,038 males [75.2%]; mean age 39.5 +/- A 10.7 years). Mean disease duration was 12.1 +/- A 8.5 years, and mean time from initial symptom to diagnosis was 5 +/- A 6.8 years (median 2 years). HLA-B27 positivity was detected in 73.7% of 262 patients tested. Manifestations of extraarticular involvement were anterior uveitis (13.2%), psoriasis and other skin and mucous membrane lesions (6%) and inflammatory bowel disease (3.8%). The prevalence of peripheral arthritis was 11.2%. In 51.7% of patients, the Bath AS Disease Activity Index was a parts per thousand yen4. But since our patients consisted of the ones with more severe disease who referred to the tertiary centers and needed a regular follow-up, they may not represent the general AS population. Disease-modifying anti-rheumatic drugs were being used by 41.9% of patients, with 16.4% using anti-TNF agents. TRASD-IP (Izlem Programi: Follow-up program) is the first AS registry in Turkey. Such databases are very useful and provide a basis for data collection from large numbers of subjects. TRASD-IP gives information on the clinical and demographic profiles of patients, and the efficacy and safety of anti-TNF drugs, examines the impact on quality of life, and provides real-life data that may be used in cost-effectiveness analyses.Öğe Discrimination ability of ASDAS estimating disease activity status in patients with ankylosing spondylitis(Wiley-Blackwell, 2010) Nas, Kemal; Yildirim, Kadir; Cevik, Remzi; Karatay, Saliha; Erdal, Akin; Baysal, Ozlem; Altay, ZuhalObjectives: To investigate discrimination ability of the Assessment of Spondyloarthritis International Society (ASAS) endorsed disease activity score (ASDAS) versions evaluating low and high disease activity in an unselected group of patients with ankylosing spondylitis (AS). Methods: Patients consecutively included into the joint database of five university hospitals were analyzed for low or high disease activity according to different criteria. Standardized mean differences (SMD) for two ASDAS versions were evaluated. Results: The ASDAS versions (back pain, morning stiffness, patient global pain, pain/swelling of peripheral joints, plus either erythrocyte sedimentation rate or C-reactive protein) discriminated high and low disease activity in subgroups according to Bath Ankylosing Spondylitis Disease Activity Score (BASDAI) and ASAS remission/partial remission criteria. ASDAS versions were also not influenced by peripheral arthritis and correlated well with other outcome measurements and acute-phase reactants. The ASDAS versions performed better than patient-reported measures or acute-phase reactants discriminating high and low disease activity status. Conclusion: Both ASDAS versions, consisting of both patient-reported data and acute-phase reactants, performed well in discriminating low and high disease activity. Further longitudinal data may better estimate the usefulness of ASDAS to assess disease activity subgroups and treatment response.Öğe Evaluating loss of productivity in patients with rheumatoid arthritis and its relationship to clinical parameters(2018) Sag, Sinem; Nas, Kemal; Sag, Mustafa Serdar; Tekeoglu, Ibrahim; Kamanli, Ayhan; Aydeniz, AysenurAim: This study investigated loss of productivity of working women and housewives with rheumatoid arthritis (RA) and analyzed the correlation of this loss with disease activity parameters and health-related quality of life. Material and Methods: The study enrolled consecutive patients presenting to rheumatology outpatient clinic between April 2016 and September 2016 who met the American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) RA classification criteria. Disease activity with the Disease Activity Score (DAS-28) as it pertains to C-reactive protein (CRP), functional status with the Duruöz hand index, activities of daily life with the Health Assessment Questionnaire (HAQ), and health-related quality of life with the short-form 36 (SF-36) questionnaire. Results: This study included 82 RA patients (56 women, 26 men) who were followed in our rheumatology outpatient clinic, and 29 healthy controls (24 women, 5 men) who were patient accompanists and patient visitors. We found no difference between housewives and employed women with RA in terms of disease activity, productivity in daily activities, anxiety, or depression, but patients with RA had higher pain, fatigue, and anxiety scores than healthy controls. Loss of productivity in daily activities was found to be correlated with disease activity and fatigue. Conclusions: In conclusion, disease activity, quality of life, and functional status are equally important in RA patients who work as housewives or in the workforce. Emotional status has an impact, especially on increasing productivity and participation in daily life, and doctors should also examine their patients from this perspectiveÖğe management of psoriatic arthritis: turkish league against rheumatism (tlar) expert opinions(Turkısh league agaınst rheumatısm, talatpasa bulvarı dumlupınar cad 40 3 cebecı dortyol, ankara, 06100, turkey, 2018) Nas, Kemal; Capkin, Erhan; Kilic, Erkan; Cevik, Remzi; Bodur, HaticeObjectives: 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.Öğe Management of Psoriatic Arthritis: Turkish League Against Rheumatism (TLAR) Expert Opinions(Turkish League Against Rheumatism, 2018) Nas, Kemal; Kilic, Erkan; Cevik, Remzi; Bodur, Hatice; Ataman, Sebnem; Ayhan, Figen; Akgul, OzgurObjectives: 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.Öğe The performance of psoriatic arthritis classification criteria in Turkish patients with psoriatic arthritis(Wiley, 2017) Nas, Kemal; Karkucak, Murat; Durmus, Bekir; Ulu, Mehmet Ali; Karatay, Saliha; Capkin, Erhan; Ulusoy, HasanObjectivesTo investigate performance of some of the published psoriatic arthritis (PsA) classification criteria as well as Assessment of Spondyloarthritis International Society (ASAS) criteria for peripheral spondyloarthritis (SpA) in Turkish patients with PsA (in early and late disease subgroups). MethodsPatients were recruited using case report forms and physical examination methods proposed by the Anatolian Group for the Assessment in Rheumatic Diseases (ANGARD). The Moll and Wright (MW), modified Fournie (MF), modified McGonagle (mMG), Vasey and Espinoza (VE), classification of PsA (CASPAR) criteria and ASAS criteria were assessed in patients with PsA who were diagnosed based on expert opinion. ResultsOne hundred and twenty-eight patients with PsA (58 male, 70 female, mean age 41.8years) were included. Thirty patients were in the early PsA and 98 patients were in the late PsA groups. Diagnostic delay was 2.6years. In the 15.6% of patients arthritis developed before the skin findings. The proportion of patients fulfilling the MW, MF, mMG, VE, CASPAR and ASAS criteria were at a ratio of 90.6%, 82.8%, 62.5%, 84.4%, 96.1% and 76.5%, respectively. In early PsA (< 12months disease duration) the proportions were 93.4%, 83.3%, 76.7%, 76.7%, 96.7% and 66.6%, respectively. On the other hand, in late PsA the proportions were 89.8%, 82.6%, 57.1%, 86.7%, 95.9%, 79.5%, respectively. ConclusionsEven though the sensitivity of PsA classification criteria in Turkish patients changes, the CASPAR criteria seems to be more prominent among all criteria for both early and late cases with its high sensitivity.Öğe Psychological status is associated with health related quality of life in patients with rheumatoid arthritis(Ios Press, 2011) Nas, Kemal; Sarac, Aysegul Jale; Gur, Ali; Cevik, Remzi; Altay, Zuhal; Erdal, Akin; Ersoy, YukselObjective: Rheumatoid arthritis (RA) is a chronic and disabling disease frequently effects physical and psychological well being. The aim of the present study was to determine the impact of psychological status on health related quality of life in patients with RA and also to assess which quality of life (QoL) instrument - disease specific and generic - is more prone to this effect. Methods: A total of 421 patients with RA recruited from joint database of five tertiary centers. Depression and anxiety risks were assessed by the Hospital Anxiety and Depression Scale (HADS); and quality of life assessed by Rheumatoid Arthritis Quality of Life (RAQoL), Nottingham Health Profile (NHP) and The Short Form 36 (SF 36) questionnaire. Results: Patients with higher risk for depression or anxiety had poorer quality of life compared to the patients without risk for depression or anxiety. Depression and anxiety scores significantly correlated with quality of life questionnaires. There was significant association between anxiety and depression with worsening in both disease specific and generic health related quality of life. However, RAQoL showed more association with depression and anxiety levels. Conclusion: Higher depression and anxiety risks showed increased deterioration in quality of life. Compared to generic QoL scales, RAQoL scale, a disease specific QoL instrument, is much more influenced by depression and anxiety.Öğe Relationship between psychological status and disease activity and quality of life in ankylosing spondylitis(Springer Heidelberg, 2011) Baysal, Ozlem; Durmus, Bekir; Ersoy, Yuksel; Altay, Zuhal; Senel, Kazim; Nas, Kemal; Ugur, MahirOur aim in this study was to compare the depression and anxiety risk in patients with AS and healthy controls and also to determine the relationship between disease activity, quality of life and psychological well-being. Two hundred and forty-three patients with ankylosing spondylitis (AS) and 118 age-, sex- and education-matched healthy controls were enroled into the study. Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), and Functional Index, and Metrology Index, Health Assessment Questionnaire for Spondyloarthropathies (HAQ-S), Hospital Anxiety and Depression Scale (HADS) including depression subscale (HADS-D) and anxiety subscale (HADS-A), Ankylosing Spondylitis Quality of Life (ASQoL) Scale, duration of morning stiffness, pain-visual analogue scale (VAS), patient and physician's global assessment of disease activity (100 mm VAS) were used to assess clinical and psychological status. Patients had similar HADS-D but higher HADS-A than healthy controls. Patients with high risk for depression and anxiety had higher scores in BASDAI, BASFI and also poorer scores in VAS pain, patient global assessment, physician global assessment, HAQ-S and ASQoL. There was a negative correlation of HADS-D and HADS-A scores with educational level of the patients. Higher scores in HADS-D and HADS-A indicated poorer functional outcome and quality of life. Multivariate logistic regression analysis revealed that the HADS-D (OR = 6.84), HAQ-S (OR = 1.76), VAS pain score (OR = 1.03) and ESR (OR = 1.02) were independent risk factors for higher anxiety scores whereas HADS-A (OR = 1.36) and ASQoL (OR = 1.24) were independent risk factors for higher depression scores. The psychological status had close interaction with disease activity and quality of life in patients with AS.Öğe Serum Level of ADAMTS4 and ADAMTS8 in Patientswith Psoriatic Arthritis(2021) İçen Taşkın, Irmak; İrtegün Kandemir, Sevgi; Nas, Kemal; Dağlı, Abdullah ZübeyirObjective: Psoriatic arthritis (PsA) is a chronic inflammatory disease associated with psoriasis. A disintegrin and metallopro teinase with thrombospondin motifs (ADAMTS) is a large family of proteoglycanase enzymes that show proteolytic activity.The expression levels of ADAMTS proteases in osteoarthritis and rheumatoid arthritis are upregulated. However, theirexpression levels in PsA patients have not been examined yet. The aim of this study was to determine the serum levels ofADAMTS4 and ADAMTS8 in PsA patients. Materials and Methods: This was a case-control study and enrolled 40 PsA patients and 40 individuals as controls. Serumlevels of ADAMTS4 and ADAMTS8 were examined by the enzyme-linked immunosorbent assay (ELISA). The relationshipbetween ADAMTS8 levels and demographic and clinical features of PsA patients were analyzed. Results: The results of this study showed that the ADAMTS8 level was significantly elevated in the serum of PsA patients(160.9±49.79 pg/mL) compared to the control groups (<15.6 pg/mL). An association (r=0.32, p<0.05) was detected betweenage and serum level of ADAMTS8. However, the level of the ADAMTS4 in many subjects was under the detectable range. Conclusion: Our results conclude that a relationship exists between ADAMTS8 and PsA, but further investigations arerequired to establish the function of ADAMTS8 proteases in PsA.Öğe Turkish League Against Rheumatism (TLAR) Recommendations for the Pharmacological management of Rheumatoid Arthritis: 2018 Update Under Guidance of Current Recommendations(Turkish League Against Rheumatism, 2018) Ataman, Sebnem; Sunar, Ismihan; Yilmaz, Gurkan; Bodur, Hatice; Nas, Kemal; Ayhan, Fikriye Figen; Akgul, OzgurObjectives: 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.Öğe Turkish League Against Rheumatism Consensus Report: Recommendations For Management of Axial Spondyloarthritis(Turkish League Against Rheumatism, 2018) Bodur, Hatice; Yurdakul, Fatma Gul; Ataman, Sebnem; Garip, Yesim; Nas, Kemal; Ayhan, Fikriye Figen; Akgul, OzgurObjectives: 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.
