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    Characteristics of patients with rheumatoid arthritis in Turkey: Results from the Turkish league against rheumatism rheumatoid arthritis registry
    (2015) Bal, Ajda; Ataman, Şebnem; Bodur, Hatice; Rezvani, Aylin; Paker, Nurdan; Taştekin, Nurettin; Uğurlu, Hatice; Göksel Karatepe, Altınay; Borman, Pınar; Yener, Mahmut; Nas, Kemal; Sezgin, Melek; Yazgan, Pelin; Tekeoğlu, İbrahim; Doğu, Beril; Altay, Zuhal; Kırnap, Mehmet; Gürgan, Alev; Gür, Ali; Hizmetli, Sami; Günendi, Zafer; Erdem, Rana; Uğurlu, Hatice; İnal, Elem; Ölmez, Neşe; Kozanoğlu, Erkan; Öken, Öznur; Özel, Sumru; Dündar, Ümit; Akıncı, Ayşen; Öztürk, Cihat; Sivrioğlu, Konçuy; Duruöz, Mehmet Tuncay; Aydoğ, Ece; Çapkın, Erhan; Altan, Lale; Evcik, Deniz; Durmuş, Oğuz; Yağcı, İlker; Şendur, Ömer Faruk; Sertpoyraz, Filiz Meryem; Özgül, Ahmet; Şenel, Kazım; Çapacı, Kazım
    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 51.612.5 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 5.23.8 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, 4.01.4, 0.380.37 ve 31.257.1 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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    Isokinetic strength of the trunk flexors and extensors in ankylosing spondylitis
    (Ios Press, 2013) Durmus, Bekir; Sahin, Nilay; Baysal, Ozlem; Ersoy, Yuksel; Baysal, Tamer; Koca, Tuba Tulay; Altay, Zuhal
    BACKGROUND: Objective measurement of trunk muscles strength in ankylosing spondylitis (AS) may provide clinical information that can be used to evaluate functional disability. OBJECTIVE: To compare the isokinetic strength of trunk muscles in AS patients with healthy subjects. METHODS: Thirty-four patients with AS and thirty-one healthy subjects were enrolled. Patients with spinal ankylosis and bridged syndesmophytes in the lumbar and dorsal vertebrae were excluded. Trunk flexor and extensor strength was measured at: 60 and 90 degrees/sec. RESULTS: When compared with the control group, AS patients demonstrated 38% and 24% decrease in the extensor and flexor strength, respectively (p < 0.05). In addition, the flexor/extensor strength ratio was 1.0 and 0.8 in the patients and control subjects, respectively. CONCLUSIONS: In view of the relatively selective extensor weakness we recommend assessment of trunk muscle strength in these patients for guiding clinicians regarding possible reconditioning exercises in the early period of AS.
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    Management of Psoriatic Arthritis: Turkish League Against Rheumatism (TLAR) Expert Opinions
    (2018) Nas, Kemal; Kılıç, Erkan; Kocabaş, Hilal; Bodur, Hatice; Ataman, Şebnem; Ayhan, Figen; Çevik, Remzi; Akgül, Özgür; Akıncı, Ayşen; Altay, Zuhal; Çapkın, Erhan; Dağlı, Abdullah Zübeyir; Duruöz, Tuncay; Gürer, Gülcan; Göğüş, Feride; Garip, Yeşim; Kaçar, Cahit; Kamanlı, Ayhan; Kaptanoğlu, Ece; Kaya, Taciser; Özdemirel, Erhan Ali; Özel, Sumru; Sezer, İlhan; Sunar, İsmihan; Yılmaz, Gürkan
    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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    Prevalence of Rheumatoid Arthritis and Spondyloarthritis in Turkey: A Nationwide Study
    (2018) Tuncer, Tiraje; Uğurlu, Hatice; Kaçar, Cahit; Kurtaiş, Yeşim; Kutlay, Şehim; Bütün, Bülent; Gilgil, Erdal; Yalçın, Peyman; Akarırmak, Ülkü; Altan, Lale; Ardıç, Füsun; Ardıçoğlu, Özge; Altay, Zuhal; Cantürk, Ferhan; Cerrahoğlu, Lale; Çevik, Remzi; Demir, Hüseyin; Durmaz, Berrin; Dursun, Nigar; Duruöz, Tuncay; Erdoğan, Canan; Evcik, Deniz; Gürsoy, Savaş; Hizmetli, Sami; Kaptanoğlu, Ece; Kayhan, Önder; Kırnap, Mehmet; Kokino, Siranuş; Kozanoğlu, Erkan; Kuran, Banu; Nas, Kemal; Öncel, Sema; Sindel, Dilşad; Orkun, Sevim; Sarpel, Tunay; Savaş, Serpil; Şendur, Ömer Faruk; Şenel, Kazım; Uğurlu, Hatice; Uzunca, Kaan; Tekeoğlu, İbrahim; Guillemin, Francis
    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 44.013.1 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 41.516.8 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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    Turkish Compliance and Adaptation of EULAR 2013 Recommendations for the Management of Rheumatoid Arthritis with Synthetic and Biological Disease-Modifying Antirheumatic Drugs: Expert Opinion of TLAR
    (2015) Ataman, Şebnem; Sarı Sürmeli, Zühre; Sunar, İsmihan; Özdemirel, Erhan; Akıncı, Ayşen; Bodur, Hatice; Kocabaş, Hilal; Akgül, Özgür; Altan, Lale; Altay, Zuhal; Ayhan, Figen; Birtane, Murat; Soy Buğdaycı, Derya; Çapkıni Erhan; Cerrahoğlu, Lale; Duruöz, Mehmet Tuncay; Günaydın, Rezzan; Günendi, Zafer; Gürer, Gülcan; Bal, Ajda; Kaçar, Cahit; Kaptanoğlu, Ece; Kaya, Taciser; Kotevoğlu, Nurdan; Nas, Kemal; Rezvani, Aylin; Şen, Nesrin; Şendur, Ömer Faruk; Yalçın, Peyman
    Objectives: This study aims to report Turkish League Against Rheumatisms 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.
  • Küçük Resim
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    Turkish League Against Rheumatism Consensus Report: Recommendations For Management of Axial Spondyloarthritis
    (2018) Bodur, Hatice; Yurdakul, Fatma Gül; Ataman, Şebnem; Garip, Yeşim; Nas, Kemal; Ayhan, Fikriye Figen; Kocabaş, Hilal; Akgül, Özgür; Akıncı, Ayşen; Altay, Zuhal; Birtane, Murat; Soy Budayıcı, Derya; Çapkın, Erhan; Çevik, Remzi; Duruöz, Tuncay; Gürer, Gülcan; Kaçar, Cahit; Kamanlı, Ayhan; Kaptanoğlu, Ece; Kaya, Taciser; Kuru, Ömer; Alkan Melikoğlu, Meltem; Özdemirel, Erhan; Özel, Sumru; Rezvani, Aylin; Sezer, İlhan; Sunar, İsmihan; Yılmaz, Gürkan
    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.