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Öğe Ankilozan spondilit tanılı hastalarda uyku kalitesinin hastalık parametreleri ile olan ilişkisinin değerlendirilmesi(İnönü Üniversitesi, 2015) Zontul, SezginAmaç: Bu çalışmanın amacı, ankilozan spondilit tanılı hastalarda uyku kalitesinin hastalık parametreleri ve uyku bozukluğu yapabilecek diğer bazı nedenler ile olan ilişkisini değerlendirmektir. Gereç ve yöntem: Çalışmaya takipleri devam eden 122 ankilozan spondilit hastası dahil edildi. Hastalar pittsburg uyku kalitesi indeksine göre uyku kalitesi iyi olanlar ve kötü olanlar olmak üzere 2 gruba ayrıldı. Hastalar yaş, cinsiyet, boy, kilo, medeni hal, eğitim durumu, tanı tarihi, tanı konulan merkez, bugüne kadar aldıkları medikal tedaviler, tedaviye bağlı yan etkiler, geçirdiği cerrahi operasyonlar ve başka bilinen kronik hastalık açısından sorgulandı. Ayrıca bu hastalardan alınan rutin kan tetkiklerinden CBC, AST, ALT, BUN, Kreatinin, sedimentasyon, CRP olgu rapor formuna kaydedildi. Hastalar VAS, short form-36 (SF-36), Uluslararası Huzursuz Bacak Sendromu Çalışma Grubu (UHBSÇG) kriterleri anketi, beck depresyon, beck anksiyete, BASMI, BASFI, BASDAI ölçekleri ile değerlendirildi. Gruplar bu ölçeklerden elde edilen sonuçlar ile karşılaştırıldı. Bulgular: Hastalarda genel popülasyona göre daha yüksek oranda kötü uyku kalitesi ve huzursuz bacak sendromu saptandı. Gruplar arasında ağrı, yaşam kalitesi, depresyon, anksiyete, BASFİ ve BASDAİ açısından istatistiksel olarak anlamlı fark saptandı. BASMI ve huzursuz bacak sendromu açısından ise anlamlı fark saptanmadı. Sonuç: Bu bulgulardan yola çıkarak AS hastalarında uyku bozukluklarına sık rastlandığı ve bunun ağrı, hastalık aktivitesi, anksiyete, depresyon, kötü yaşam kalitesi ve fonksiyonel durum ile yakından ilişkili olduğu saptanmıştır. Ayrıca huzursuz bacak sendromunun AS hastalarında sık rastlanan bir durum olduğu sonucuna varılmıştır. Anahtar kelimeler: Ankilozan spondilit, uyku kalitesi, yaşam kalitesi, huzursuz bacakÖğe Can nailfold capillaroscopy findings be a marker for uveitis in Behçet’s syndrome?(Clinical and Experimental Rheumatology S.A.S., 2025) Zontul, Sezgin; İnanç, Elif; Can, Ahmet; Tay, Şeyma Tokay; Çolak, Hüseyin; Cumurcu, Tongabay; Yolbas, ServetObjective To evaluate the differences between BS patients with uveitis and BS patients without uveitis and healthy controls in terms of nailfold capillaroscopic examination. Methods The study was performed on patients with a definite diagnosis of BS according to the International Criteria for Behçet’s Disease, and healthy controls without BS. The participants were divided into three groups: BS patients with uveitis, BS patients without uveitis and healthy controls. All volunteers were examined by nailfold capillaroscopy for microvascular changes. Results A sample size of 90 participants, including 32 patients with BS with uveitis, 29 patients with BS without uveitis and 29 healthy controls, were included in our study. Fourteen (15.6%) BS patients with uveitis, 14 (15.6%) BS patients without uveitis and 16 (17.8%) healthy controls were female. In our study, we found microhaemorrhage occurrence to be significantly higher in BS patients with uveitis compared to the healthy control group (p=0.028). Although there was no significant difference compared to the BS without uveitis group, microhaemorrhage was approximately 2.5 times more common in the BS with uveitis group. The crossing medians were determined as 2.0 (0.8-3.3) in the BS with uveitis group, 1.3 (0.6-2.7) in the BS without uveitis group and 1.2 (0-3.2) in the healthy control group, showing a statistically significant difference across groups (p<0.001). In the post hoc crossing analysis, a significant difference was detected in the BS with uveitis group compared to the other two groups. A giant capillary was detected in one of the patients with uveitis, but no giant capillary was detected in the volunteers in the other groups. Conclusion Our findings show that microhemorrhage and crossing are associated with uveitis in BS patients. © Copyright CLINICAL AND EXPERIMENTAL RHEUMATOLOGY 2025.Öğe Colchicine-Tolerant vs. Resistant Familial Mediterranean Fever: Comparative Analysis of Clinical, Psychosocial Characteristics and Quality of Life(Mdpi, 2026) Kaya, Zeynep; Sag, Sinem; Kaya, Mehmet Nur; Zontul, Sezgin; Yolbas, ServetBackground/Objectives: Familial Mediterranean Fever (FMF) is a chronic autoinflammatory disease in which some patients develop resistance to colchicine, resulting in persistent attacks and increased disease burden. This study aimed to compare clinical characteristics, disease activity, psychological status, and quality of life between colchicine-tolerant and colchicine-resistant FMF patients, and to identify clinical factors independently associated with colchicine resistance. Methods: This exploratory cross-sectional observational study was conducted in 120 FMF patients followed at a tertiary rheumatology center. Patients were classified as colchicine-tolerant or colchicine-resistant. Disease activity and damage were assessed using the International Severity Scoring System for FMF (ISSF) and the Autoinflammatory Disease Damage Index (ADDI). Quality of life was evaluated using the FMF-Health-Related Quality of Life (FMF-HQL) and WHO Quality of Life-BREF (WHOQoL-BREF) questionnaires. Anxiety and depression were assessed using the Hospital Anxiety and Depression Scale (HADS). Results: Colchicine-resistant patients had significantly higher attack frequency and disease activity scores (p < 0.001). Quality of life was impaired, with higher FMF-HQL and lower WHOQoL-BREF scores across all domains (p < 0.001). Anxiety and depression scores were also higher. ISSF and Doctor Global Assessment (DGA) were independently associated with colchicine resistance. Conclusions: Colchicine resistance in FMF was associated with increased disease activity, impaired quality of life, and greater psychological burden.Öğe INCREASED PREVALENCE OF SCOLIOSIS IN PSORIATIC ARTHRITIS: A CROSS-SECTIONAL CASE-CONTROL STUDY(2025) Gözükara Bag, Harika Gözde; Ergen, Emre; Yolbas, Servet; Aydogdu, Mesude Seda; Kaya, Zeynep; Zontul, Sezgin; İnanç, ElifAim: Psoriatic arthritis (PsA) is expected to cause an increased risk of scoliosis because it affects the axial skeleton asymmetrically. In this study, we compared the frequency of scoliosis in PsA patients with that in healthy controls (HC) and axial spondyloarthritis (axSpA) patients. Thus, we aimed to explore whether scoliosis might be a clinical feature of PsA and to assess its potential role in differentiating PsA from axSpA. Material and Methods: The study included 60 PsA patients, 60 axSpA patients and 40 HC. All individu-als in the study were assessed for the presence of scoliosis by physical examination. Scoliosis radiog-raphy was performed in those with a positive scoliosis test on physical examination. The Cobb angle was measured using the appropriate method. A two-tailed significance level of 0.05 was considered in all analyses. Results: Within this research, the frequency of scoliosis in PsA patients was compared with the axSpA and HC groups. The Cobb angle value was notably higher in the PsA group compared to axSpA and HC (p=0.006 and p=0.007, respectively). On physical examination, scoliosis findings and coronal spinal curvature, were observed at elevated rates in the PsA group relative to the other two groups (p>0.05 for all, indicating no statistical significance). Scoliosis was more frequent in the PsA group than in the axSpA group (p=0.046). All scoliosis cases in PsA were in mild or moderate severity. Conclusion: Both the frequency of scoliosis and Cobb angle values were greater in PsA than those in axSpA. This outcome may be associated with the asymmetric involvement of lateral spinal structures typical of PsA. Overall, these results indicate that scoliosis could serve as a supportive marker for PsA and may aid in differentiating PsA from axSpA.Öğe Is combining methotrexate and leflunomide a safe option for treating rheumatoid arthritis?(2025) Aktürk, Semra; Yolbas, Servet; Güneş, Hatice Kübra; Kürüm, Kübra Orhan; Zontul, Sezgin; İnanç, Elif; Çulcu, Sena CengizRheumatoid arthritis (RA) is a chronic immune-mediated disease marked by synovial inflammation and systemic features. Early management typically relies on conventional synthetic disease-modifying antirheumatic drugs (csDMARDs), with methotrexate (Mtx) serving as the primary therapeutic agent. When Mtx is contraindicated, leflunomide (Lef) can be used as a treatment strategy. There are concerns about hepatotoxicity, cytopenia, pneumonia, and increased risk of infection when these therapies are combined. In this study, we aimed to evaluate the side effects and treatment duration of the Mtx/Lef combination in patients with RA. All patients admitted to the Rheumatology clinic between 2016 and 2023 and diagnosed with RA were retrospectively reviewed. Patients who received Mtx/Lef combination therapy during this period were identified. The data for patients who continued Mtx/Lef combination therapy were recorded at the last visit, and those who discontinued the combination therapy were recorded at the visit of discontinuation. Adverse effects associated with Mtx/Lef combination therapy were assessed through retrospective review of clinical follow-up notes, laboratory test results, and drug safety monitoring forms. Adverse events leading to treatment discontinuation were classified as either due to side effects or lack of therapeutic response. This study was conducted with a total of 222 participants, comprising 184 females (82.9%) and 38 males (17.1%). No side effects were observed in 141 (63.5%) patients after Mtx/Lef use. Gastrointestinal system side effects were observed in 16.7% of the participants, followed by elevated liver function tests in 11.3%. It was determined that 55% of the participants were unable to continue treatment due to treatment ineffectiveness or side effects. Our study results offer a good safety profile and long-term drug survival. Survival in long-term treatment may contribute to reducing treatment costs.Öğe Knee Arthralgia and Cartilage Thinning in Psoriasis: Clues to Early Psoriatic Arthritis?(Wiley, 2025) Akturk, Semra; Buyukavci, Raikan; Zontul, Sezgin; Kanat, Zekiye; Altunisik, Nihal; Altun, Belda; Simsek, EmrahBackground: To compare femoral cartilage thickness between patients with psoriasis (PsO) and psoriatic arthritis (PsA), and to investigate whether knee joint pain in PsO patients could be an early risk factor for PsA. Methods: Fifty-nine patients (28 PsO and 31 PsA) were included in this cross-sectional study. Demographic data were collected, and clinical assessments were performed using the Psoriasis Area and Severity Index (PASI) and the Disease Activity Score 28 (DAS28). PsO patients were evaluated for knee arthralgia symptoms within the past month. Femoral cartilage thickness was measured bilaterally at the medial femoral condyle, lateral femoral condyle, and intercondylar area using ultrasonography. Results: Femoral cartilage thickness was significantly lower in PsA patients compared to those with PsO (p < 0.05). Among patients with PsO, those reporting arthralgia (n = 14) had significantly reduced lateral femoral condyle cartilage thickness in both knees compared to those without arthralgia (p < 0.05). Spearman correlation analysis revealed a negative correlation between age and lateral cartilage thickness (e.g., right LFC: rho = -0.338, p = 0.009, 95% CI -0.55 to -0.09). PASI scores showed a consistent positive correlation with femoral cartilage thickness across regions; for example, the correlation with the left LFC was significant (rho = 0.504, p < 0.01, 95% CI 0.29-0.67). These associations indicate that both demographic and disease-related factors may influence cartilage status in PsO and PsA, although the confidence intervals indicate some degree of uncertainty and call for validation in larger cohorts. Conclusions: Femoral cartilage thinning is evident in PsA patients and may begin even in the subclinical phase. In PsO patients, the presence of arthralgia, especially in the lateral femoral condyle, may reflect early structural changes and could serve as a predictor for PsA development. Ultrasonographic assessment offers a noninvasive, accessible method for early detection and follow-up.Öğe The Effect of Clinical Knowledge on the Evaluation of Sacroiliac Joint Radiography in Patients with Spondyloarthritis(Mdpi, 2025) Zontul, Sezgin; Kaya, Zeynep; Aydogdu, Mesude Seda; Arslan, Ahmet Kadir; Inanc, Elif; Maras Ozdemir, Zeynep; Yolbas, ServetBackground/Objectives: This study investigates whether a patient's clinical status influences the evaluation of sacroiliac joint (SIJ) radiographs. Methods: The study involved analysing SIJ radiographs of patients diagnosed with spondyloarthritis (SpA) at our clinic. Two rheumatologists working at another centre evaluated the images independently. Three months were allowed to elapse so that the rheumatologists would forget the results of the first evaluation. The radiographs were then re-evaluated in a different order by the same rheumatologists. However, during the second evaluation, the evaluators were also provided with general clinical information about the patients. Inter- and intra-observer agreement were assessed. Results: In the first blinded evaluation of our study, we found moderate-to-substantial agreement between rheumatologists (right kappa: 0.534; p < 0.001; left kappa: 0.609; p < 0.001) and statistically significant interpretation agreement. In the second evaluation, we observed an increase in agreement (kappa increased from 0.534 to 0.774 for the right SIJ and from 0.609 to 0.855 for the left SIJ), and these metrics were also significant. Conclusions: The interpretation of SIJ radiographs showed notable inter-observer variability in the absence of clinical information. Incorporating clinical context significantly improved the agreement between readers. As conventional radiography remains central to spondyloarthritis classification, these findings highlight the value of clinical data in enhancing the reliability of radiographic assessment. To our knowledge, this is the first study to systematically demonstrate the impact of clinical information on inter-observer agreement in SIJ radiograph interpretation.Öğe The Relationship of Serum Vitamin B12 and Ferritin Levels with Disease Severity and Neuropathic Pain in Fibromyalgia Syndrome(Coll Physicians & Surgeons Pakistan, 2025) Bingol, Meral Kirmizi; Akturk, Semra; Buyukavci, Raikan; Zontul, SezginObjective: To investigate the relationship of serum vitamin B12 (vB12) and ferritin levels with disease severity and neuropathic pain in fibromyalgia syndrome (FMS). Study Design: Observational study. Place and Duration of the Study: Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Inonu University, Malatya, Turkiye, from October to December 2023. Methodology: A total of 110 patients, aged between 18 and 65 years, diagnosed with FMS according to the 2016 ACR diagnostic criteria, were included in this study. The participants were evaluated using the Fibromyalgia Impact Questionnaire (FIQ) to measure symptoms impacting daily activities such as pain, sleep disturbances, and fatigue. The Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) is a clinical scale used to investigate the neuropathic component of pain. The serum levels of vB12 and ferritin were compared between the patients with and without neuropathic pain symptoms and the impact of these parameters on disease severity and activities of daily life was analysed. Results: Among the participants, 105 were females and 5 were males. Sixty-nine patients reported neuropathic pain, while 41 did not. Patients with neuropathic pain had significantly higher VAS and FIQ scores and significantly lower vB12 and ferritin levels (p <0.05). A significant inverse relationship was found between FIQ scores and both vB12 levels (p = 0.047, r =-0.190) and ferritin levels (p = 0.007, r =-0.256). Conclusion: In this study, fibromyalgia patients with neuropathic pain had higher pain and disease activity scores, and low serum vB12 and ferritin levels were found to be associated with disease severity and neuropathic pain.Öğe Use of nailfold capillaroscopy for the assessment of patients undergoing digit replantation and revascularization(Turkish Joint Diseases Foundation, 2024) Koroglu, Muhammed; Karakaplan, Mustafa; Zontul, Sezgin; Acet, Omer; Ozdes, Hueseyin Utku; Ergen, Emre; Aslanturk, OkanObjectives: In this study, we aimed to evaluate microvascular changes using nailfold capillaroscopy in patients who underwent digit replantation and revascularization. Patients and methods: A total of 46 patients (34 males, 12 females; mean age: 45.8 +/- 17.6 years; range, 18 to 75 years) who underwent replantation or revascularization procedures between February 2012 and May 2023 were retrospectively analyzed. Nailfold capillaroscopy images were assessed for various parameters including capillary count, diameter, dilatation, presence of giant capillaries, capillary disarrangement, microhemorrhages, neoangiogenesis, subpapillary plexus appearance, crossing capillaries, tortuosity, and microaneurysm. We investigated the association between microvascular alterations and clinical outcomes. Results: Of 46 patients, 25 patients underwent replantation and 21 patients underwent revascularization. Significant microvascular changes, including subpapillary venous plexus, microvascular enlargement, microhemorrhages, neoangiogenesis, and tortuosity were observed in replantation patients (p=0.000(b) , p=0.020, p=0.021(b) , p=0.001, and p=0.004, respectively). However, these changes were not significant in revascularization patients. Revascularization patients exhibited an increase in capillary diameter and disarrangement (p=0.019 and p=0.016(b) , respectively). A significant negative correlation existed between digital nerve repairs and microvascular enlargement in replantation patients. Hyperesthesia was significantly correlated with neoangiogenesis and capillary disarrangement, while a statistically significant positive relationship was found between subpapillary venous plexus and patient satisfaction in replantation patients. Conclusion: Our study showed that replantation patients who underwent two nerve repairs exhibited a well-regulated microvascular tone. However, we did not observe a statistically significant relationship between the number of nerve repairs and cold intolerance. Based on these findings, we highlight the potential of nailfold capillaroscopy in detecting microvascular changes following replantation and revascularization, which may contribute to a better understanding of the etiology of neurovascular complications.Öğe Use of nailfold capillaroscopy for the assessment of patients undergoing digit replantation and revascularization [2](Turkish Joint Diseases Foundation, 2025) Koeroglu, Muhammed; Karakaplan, Mustafa; Zontul, Sezgin; Acet, Omer; Ozdes, Hueseyin Utku; Ergen, Emre; Aslanturk, OkanObjectives: In this study, we aimed to evaluate microvascular changes using nailfold capillaroscopy in patients who underwent digit replantation and revascularization. Patients and methods: A total of 46 patients (34 males, 12 females; mean age: 45.8 +/- 17.6 years; range, 18 to 75 years) who underwent replantation or revascularization procedures between February 2012 and May 2023 were retrospectively analyzed. Nailfold capillaroscopy images were assessed for various parameters including capillary count, diameter, dilatation, presence of giant capillaries, capillary disarrangement, microhemorrhages, neoangiogenesis, subpapillary plexus appearance, crossing capillaries, tortuosity, and microaneurysm. We investigated the association between microvascular alterations and clinical outcomes. Results: Of 46 patients, 25 patients underwent replantation and 21 patients underwent revascularization. Significant microvascular changes, including subpapillary venous plexus, microvascular enlargement, microhemorrhages, neoangiogenesis, and tortuosity were observed in replantation patients (p=0.000b, p=0.020, p=0.021b, p=0.001, and p=0.004, respectively). However, these changes were not significant in revascularization patients. Revascularization patients exhibited an increase in capillary diameter and disarrangement (p=0.019 and p=0.016b, respectively). A significant negative correlation existed between digital nerve repairs and microvascular enlargement in replantation patients. Hyperesthesia was significantly correlated with neoangiogenesis and capillary disarrangement, while a statistically significant positive relationship was found between subpapillary venous plexus and patient satisfaction in replantation patients. Conclusion: Our study showed that replantation patients who underwent two nerve repairs exhibited a well-regulated microvascular tone. However, we did not observe a statistically significant relationship between the number of nerve repairs and cold intolerance. Based on these findings, we highlight the potential of nailfold capillaroscopy in detecting microvascular changes following replantation and revascularization, which may contribute to a better understanding of the etiology of neurovascular complications.
