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Association of pain and clinical factors on disability and quality of life in systemic sclerosis: A cross-sectional study from Turkish League Against Rheumatism Network
(Turkish League Against Rheumatism, 2023) Cevik, Remzi; Em, Serda; Nas, Kemal; Toprak, Murat; Cengiz, Gizem; Calis, Mustafa; Sezer, Ilhan
Objectives: In this study, we aimed to evaluate the factors associated with disability and quality of life (QoL) in Turkish patients with systemic sclerosis (SSc). Patients and methods: Between January 2018 and January 2019, a total of 256 SSc patients (20 males, 236 females; mean age: 50.9 +/- 12.4 years; range, 19 to 87 years) who were diagnosed with SSc were included in the study. Disability and health-related QoL (HRQoL) were evaluated by the Health Assessment Questionnaire (HAQ), scleroderma HAQ (SHAQ), Duruoz Hand Index (DHI), and Short Form-36 (SF-36). Linear regression analysis methods were used to describe factors associated with disability and QoL of the patients. Results: All disability scores were higher and HRQoL scores were lower in diffuse cutaneous SSc patients compared limited cutaneous SSc, and differentiations were significant (p= 0.001 and p= 0.007). In multiple regression, pain (VAS) was the strongest predictor for high disability and low QoL scores (p<0.001) as HAQ (beta=0.397, 0.386, 0.452), SHAQ (beta=0.397, 0.448, 0.372), DHI (beta=0.446, 0.536, 0.389), PCS (beta=- 0.417,- 0.499, -0.408) and MCS (beta=-0.478, -0.441, -0.370) in combined, lcSSc and dcSSc patients respectively. The factors associated with high disability and low QoL scores were forced vital capacity for HAQ (beta=- 0.172, p=0.002) and SF-36 PCS (beta= 0.187, p= 0.001); disease duration for HAQ (beta=0.208, p<0.001), DHI (beta=0.147, p=0.006), and SF-36 PCS (beta=-0.134, p= 0.014); 6-minute walk test for HAQ (beta=- 0.161, p= 0.005) and SF-36 PCS (beta= 0.153, p=0.009); and modified Rodnan skin score for SHAQ (beta= 0.250, p<0.001) and DHI (beta=0.233, p<0.001) in SSc patients. Diffusing capacity of the lungs for carbon monoxide for HAQ (beta=- 0.189, p=0.010) and SHAQ (beta=-0.247, p= 0.002); erythrocyte sedimentation rate for DHI (beta=0.322, p<0.001); age for SF-36 PCS (beta=-0.221, p=0.003) and body mass index for SF-36 PCS (beta=-0.200, p=0.008) and MCS (beta=-0.175, p=0.034) were the other variables associated with high disability or low QoL scores in SSc subsets. Conclusion: Clinicians should consider the management of the pain and its sources as a key to improve better functional state and quality of daily life in SSc.
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.
Clinical characteristics, disease activity, functional status, and quality of life results of patients with psoriatic arthritis using biological and conventional synthetic disease-modifying antirheumatic drugs
(Turkish League Against Rheumatism, 2021) Keskin, Yasar; Nas, Kemal; Kilic, Erkan; Sargin, Betul; Kasman, Sevtap Acer; Alkan, Hakan; Sahin, Nilay
Objectives: This study aims to compare the clinical characteristics, disease activity, and quality of life (QoL) of patients with psoriatic arthritis (PsA) who use biological and conventional synthetic disease-modifying antirheumatic drugs (DMARDs) in a nationwide cohort throughout Turkey. Patients and methods: A total of 961 patients (346 males, 615 females; mean age: 46.9+/-12.2 years; range, 18 to 81 years) with PsA according to the classification criteria for PsA were included in the study. The patients demographic and clinical characteristics, physical examination results, Disease Activity Score 28, Disease Activity Index for Psoriatic Arthritis and Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Psoriasis Area and Severity Index, Bath Ankylosing Spondylitis Functional Index, Bath Ankylosing Spondylitis Metrology Index, Hospital Anxiety and Depression Scale, Health Assessment Questionnaire, Psoriatic Arthritis Quality of Life (PsAQoL), and Short Form-36 scores were all recorded. Results: Of the patients, 23% underwent biological DMARD (bDMARD) monotherapy, 42% underwent conventional synthetic DMARD (csDMARD) monotherapy, 10% underwent a csDMARD combination therapy, and 10% underwent a combination bDMARD and csDMARD treatment. The Visual Analog Scale (VAS pain), patient global assessment, physician global assessment, and BASDAI scores were found to be lower among patients using combination treatment of csDMARD and bDMARD, while the swollen joint count was found to be lower among patients using bDMARD. The PsAQoL score was found to be the lowest among patients not using any medication and the highest among those using bDMARD. Conclusion: In our study, patients with PsA were successfully treated with both csDMARD and bDMARD monotherapy. When the biological treatments used for PsA were compared with csDMARD, it was found that biological treatments had a positive effect on both disease activity and the QoL. Combinations of csDMARDs and bDMARDs were preferred in cases in which the disease activity was still high or increased. Because of the highest efficacy of the combined treatment, we highly suggest increasing the number of patients on combined treatment.
The effect of gender on disease activity and clinical characteristics in patients with axial psoriatic arthritis
(Taylor & Francis Ltd, 2021) Nas, Kemal; Kilic, Erkan; Tekeoglu, Ibrahim; Keskin, Yasar; cevik, Remzi; Sargin, Betul; Acer Kasman, Sevtap
Objectives In this study, we aimed to evaluate the effect of gender on clinical findings, disease activity, functional status and quality of life in patients with axial involvement in Turkey. Methods Patients with PsA who met the CASPAR classification criteria were enrolled consequently in this cohort. Turkish League Against Rheumatism (TLAR)-Network was formed with the participation of 25 centres. The demographic variables, fatigue, diagnostic delay, the beginning of peripheral arthritis, enthesitis, dactylitis and spine involvement, inflammatory low back pain, BASFI, HAQ, HAQ-s, visual analogue scale-pain (VAS-pain), anxiety, depression and disease activity parameters (ESR, DAS28, BASDAI) were recorded. Axial involvement was assessed according to clinical and radiological data according to modified New York (MNYC) or Assessment of SpondyloArthritis international Society (ASAS) criteria. Results A total of 1018 patients with PsA were included in this study. Of the 373 patients with axial involvement, 150 were male (40.2%) and 223 (59.8%) were female. Spondylitis was detected in 14,7% of men and 21,9% of women in all patients. Pain score (VAS) (p < .002), fatigue (p < .001), ESR (p < .001), DAS28 (p < .001), BASDAI score (p < .001), PsAQoL (p < .001), HAQ score (p < ,01), HAQ-S score (p < .001), anxiety (p < .001), depression (p < .024), FACIT (p < .001) and FiRST (p < .001) scores were statistically significantly worse in women than males with axial PsA. However, quality of life was better (p < .001) and PASI score (p < .005) were statistically worse in male patients than in female patients with axial involvement. Conclusion This study has shown that the burden of disease in axial PsA has significant difference between genders. Disease activity, physical disability, functional limitation, depression and anxiety scores were higher in female patients, while quality of life were better and PASI score were higher in male patients. Therefore, we suggest that new strategies should be developed for more effective treatment of axial PsA in female patients.
THE EFFECT OF GENDER ON DISEASE ACTIVITY, FUNCTIONAL INDEX AND QUALITY OF LIFE IN PATIENTS WITH AXIAL SPA. THE DATA OF TLAR-NETWORK PSA STUDY
(Bmj Publishing Group, 2019) Nas, Kemal; Kilic, Erkan; Tekeoglu, Ibrahim; Cevik, Remzi; Sargin, Betul; Kasman, Sevtap Acer; Alkan, Hakan
[Abstract Not Availabe]
Enthesitis and its relationship with disease activity, functional status, and quality of life in psoriatic arthritis: a multi-center study
(Springer Heidelberg, 2020) Sunar, Ismihan; Ataman, Sebnem; Nas, Kemal; Kilic, Erkan; Sargin, Betul; Kasman, Sevtap Acer; Alkan, Hakan
Psoriatic arthritis (PsA) is an inflammatory arthritis with distinct phenotypic subtypes. Enthesitis is assigned as a hallmark of the disease, given its significant relations to disease activity and quality of life. Our objective is to evaluate the prevalence of enthesitis and its association with some clinical parameters, particularly quality of life, using data from a national registry. Patients with PsA meeting ClASsification criteria for Psoriatic Arthritis (CASPAR) were enrolled by means of a multi-centre Turkish League Against Rheumatism (TLAR) Network Project. The following information was recorded in web-based case report forms: demographic, clinical and radiographic data; physical examination findings, including tender and swollen joint counts (TJC and SJC); nail and skin involvement; Disease Activity Score-28 for Rheumatoid Arthritis with Erythrocyte Sedimentation Rate (DAS 28-ESR); Bath Ankylosing Spondylitis Disease Activity Index (BASDAI); Maastricht Ankylosing Spondylitis Enthesitis Score (MASES); Psoriasis Area Severity Index (PASI); Bath Ankylosing Spondylitis Radiology Index for the spine (BASRI-s); Health Assessment Questionnaire (HAQ); Bath Ankylosing Spondylitis Functional Index (BASFI); Health Assessment Questionnaire for the spondyloarthropathies (HAQ-s); Psoriatic arthritis quality of Life scale (PsAQoL); Short Form 36 (SF-36); Hospital Anxiety Depression Scale (HADS); Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F); and Fibromyalgia Rapid Screening Tool (FiRST) scores. The patients were divided into two groups, namely with and without enthesitis, based on the triple Likert-type physician-reported statement of 'active enthesitis', 'history of enthesitis' or 'none' in the case report forms. Patients with active enthesitis were compared to others in terms of these clinical parameters. A total of 1130 patients were enrolled in this observational study. Of these patients, 251 (22.2%) had active enthesitis according to the clinical assessment. TJC, HAQ-s, BASDAI, FiRST and PsAQoL were significantly higher whereas the SF-36 scores were lower in patients with enthesitis (p < 0.05). Chronic back pain, dactylitis, and tenosynovitis were more frequent in the enthesopathy group (59.4%/39%, 13.1%/6.5% and 24.7%/3.4%, respectively). Significant positive correlations between the MASES score and the TJC, HAQ, DAS 28-ESR, BASDAI, FiRST and PsAQoL scores, and a negative correlation with the SF-36 score were found. When linear regression analysis was performed, the SF-36 MCS and PCS scores decreased by - 9.740 and - 11.795 units, and the FiRST scores increased by 1.223 units in patients with enthesitis. Enthesitis is an important involvement of PsA with significant relations to quality of life determined with PsAQoL and SF-36 scores. Our study found higher frequency of dactylitis and chronic back pain, and worse quality of life determined with SF-36 and PsAQoL scores in patients with enthesitis.
A Gender-based Analysis of Disease Activity and Its Relationship with Anxiety, Depression, Fatigue, and Fibromyalgia in Psoriatic Arthritis
(Wiley, 2019) Duruoz, Mehmet Tuncay; Gezer, Halise Hande; Nas, Kemal; Kilic, Erkan; Sargin, Betul; Kasman, Sevtap Acer; Alkan, Hakan
[Abstract Not Availabe]
Gender-related differences in disease activity and clinical features in patients with peripheral psoriatic arthritis: A multi-center study
(Elsevier France-Editions Scientifiques Medicales Elsevier, 2021) Duruoz, Mehmet Tuncay; Gezer, Halise Hande; Nas, Kemal; Kilic, Erkan; Sargin, Betul; Kasman, Sevtap Acer; Alkan, Hakan
Objective: This study sought to compare disease activity, clinical features, and patient-reported outcomes concerning anxiety, depression, fatigue, function, quality of life, and fibromyalgia between female and male patients with peripheral PsA in a Turkish population. Methods: This multi-center Turkish League Against Rheumatism (TLAR) Network study included 1038 patients (678 females, 360 males) diagnosed with peripheral PsA according to the CASPAR criteria. The demographic and clinic parameters of the patients were recorded. Disease activity was evaluated using the scores of DAS28 and cDAPSA. Remission, minimal disease activity (MDA), and very low disease activity (VLDA) were determined. Health Assessment Questionnaire (HAQ), Short-Form-36 (SF-36), Hospital Anxiety and Depression Scale (HAD), fatigue VAS (0-10), and Fibromyalgia Rapid ScreeningTool (FiRST) were used. Disease activity and patient-reported outcomes were compared in male and female patients, and the predictors of MDA for both genders were analyzed. Results: The patients' mean age was 47.6 years (SD: 12) for females and 46.3 years (SD: 12.3) for males. In terms of DAS28 and cDAPSA, female patients had significantly higher disease activity scores, while male patients had significantly higher remission rates (P<0.05). There was a significant difference in the rate of MDA in favor of males (P<0.05), but not in VLDA. The incidences of dactylitis, enthesitis, tenosynovitis, and inflammatory bowel disease were similar in male and female patients, except for spondylitis, which was higher in males (P<0.05). Overall, although there was no significant between-group difference in age and disease duration, female patients had significantly higher BMI and late-onset disease (P<0.05). Female patients had higher HAD, HAQ, and FiRST and lower SF-36 scores than males (P<0.05). In both male and female patients, the disease activity score of cDAPSA was significantly correlated with the scores of FiRST, HAD, VAS-F, and HAQ(P< 0.05). In regression analysis, tender joint count, swollen joint count, PASI, pain VAS, and enthesitis were the MDA predictors in both genders. Conclusion: In patients with peripheral PsA, males are more likely to develop spondylitis while other extraarticular manifestations are similar. Female patients appear to have lower rates of remission and MDA and higher levels of disease activity. Female patients experience a more severe course of PsA, with higher levels of pain and fatigue, lower quality of life, and increased functional limitations. The predictors of MDA, i.e., tender joint count, swollen joint count, PASI, pain VAS, and enthesitis are similar between the two genders. (C) 2021 Societe francaise de rhumatologie. Published by Elsevier Masson SAS. All rights reserved.
The impact of fatigue on patients with psoriatic arthritis: a multi-center study of the TLAR-network
(Springer Heidelberg, 2020) Duruoz, Mehmet Tuncay; Gezer, Halise Hande; Nas, Kemal; Kilic, Erkan; Sargin, Betul; Acer Kasman, Sevtap; Alkan, Hakan
Fatigue is a substantial problem in patients with psoriatic arthritis (PsA) that needs to be considered in the core set of domains. This study aimed to evaluate fatigue and its relationship with disease parameters, functional disability, anxiety, depression, quality of life, and correlation with disease activity as determined by various scales. A total of 1028 patients (677 females, 351 males) with PsA who met the CASPAR criteria were included [Turkish League Against Rheumatism (TLAR) Network multicenter study]. The demographic features and clinical conditions of the patients were recorded. Correlations between fatigue score and clinical parameters were evaluated using the Disease Activity Score 28 (DAS28), Disease Activity in Psoriatic Arthritis (DAPSA), Clinical DAPSA (cDAPSA), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), the Fibromyalgia Rapid Screening Tool (FiRST), minimal disease activity (MDA), and very low disease activity (VLDA). Fatigue was assessed with the Functional Assessment of Chronic Illness Therapy (FACIT-F) and a 10-point VAS (VAS-F). The mean age of the patients was 47 (SD: 12.2) years, and the mean disease duration was 6.4 (SD: 7.3) years. The mean VAS-F score was 5.1 (SD: 2.7), with fatigue being absent or mild, moderate, and severe in 12.8%, 24.6%, and 62.5% of the patients, respectively. Fatigue scores were significantly better in patients with DAS28 remission, DAPSA remission, cDAPSA remission, MDA, and VLDA (p < 0.001). Fatigue scores significantly increased with increasing disease activity levels on the DAS28, DAPSA, and cDAPSA (p < 0.001). VAS-F scores showed correlations with the scores of the BASDAI, BASFI, PsAQoL, HAD-A, FiRST, pain VAS, and PtGA. FiRST scores showed fibromyalgia in 255 (24.8%) patients. FACIT-F and VAS-F scores were significantly higher in patients with fibromyalgia (p < 0.001). In regression analysis, VLDA, BASDAI score, FiRST score, high education level, HAD-Anxiety, and BMI showed independent associations with fatigue. Our findings showed that fatigue was a common symptom in PsA and disease activity was the most substantial predictor, with fatigue being less in patients in remission, MDA, and VLDA. Other correlates of fatigue were female gender, educational level, anxiety, quality of life, function, pain, and fibromyalgia.
The impact of nail psoriasis on disease activity, quality of life, and clinical variables in patients with psoriatic arthritis: A cross-sectional multicenter study
(Wiley, 2023) Cengiz, Gizem; Nas, Kemal; Keskin, Yasar; Kilic, Erkan; Sargin, Betul; Kasman, Sevtap Acer; Alkan, Hakan
Aim Nail involvement is common in psoriatic arthritis. This study assesses clinical characteristics, nail psoriasis prevalence, and impact of nail psoriasis on disease activity in patients with psoriatic arthritis (PsA). Method This cross-sectional multicenter study was conducted by the Turkish League Against Rheumatism using PsA patients recruited from 25 centers. Demographic and clinical characteristics of PsA patients, such as disease activity measures, quality of life, and nail involvement findings were assessed during routine follow-up examinations. Patients were divided into two groups according to the presence or absence of nail psoriasis and compared using the chi(2) test or Fisher exact test for categorical variables and the t-test or Mann-Whitney U test for continuous variables. Results In 1122 individuals with PsA, 645 (57.5%) displayed nail psoriasis. The most frequent features of fingernails were ridges (38%), followed by pitting (21%) and onycholysis (19%). More females were present in both groups (with and without nail psoriasis; 64% vs 67%, P < 0.282). Patients with nail psoriasis were older, indicated more pain and fatigue, experienced greater swelling, tender joint counts, and skin disease severity, and had a higher disease activity score compared with those without nail psoriasis (all P < 0.05). Conclusion We demonstrate an increased prevalence of nail psoriasis observed in patients with psoriatic arthritis. Patients with nail involvement experience increased disease activity, lower quality of life, and diminished mental and physical status compared with those without nail involvement.
Impact of obesity on quality of life, psychological status, and disease activity in psoriatic arthritis: a multi-center study
(Springer Heidelberg, 2022) Gok, Kevser; Nas, Kemal; Tekeoglu, Ibrahim; Sunar, Ismihan; Keskin, Yasar; Kilic, Erkan; Sargin, Betul
This article aims to evaluate the possible effect of obesity on quality of life, psychological status, and other clinical variables in Psoriatic arthritis (PsA). PsA patients have been recruited by the Turkish League Against Rheumatism-Network from various centers in Turkey in this cross-sectional study. Patients with a body mass index (BMI) >= of 30 kg/m(2) were considered obese. Differences among patients with regard to obesity status were assessed with health-related quality of life measures (PsA Quality of Life Questionnaire [PsAQoL]), psychological status (Hospital Anxiety and Depression Scale [HADS]), and disease activity parameters (the Disease Activity index for PSoriatic Arthritis [DAPSA], Disease Activity Score 28-C-reactive protein [DAS28-CRP], Bath Ankylosing Spondylitis Disease Activity Index [BASDAI], Psoriasis Area and Severity Index [PASI]), physical functions (Ankylosing Spondylitis Functional Index [BASFI], Health Assessment Questionnaire [HAQ], and Health Assessment Questionnaire for the spondyloarthropathies [HAQ-S]). Pain was assessed using visual analog scale of pain (VAS-P), and fatigue was evaluated using visual analog scale of fatigue (VAS-F) and Functional Assessment of Chronic Illness Therapy (FACIT). A total of 1033 patients with PsA, 650 (62.9%) non-obese and 383 (37.1%) obese were included in the study. The PsAQoL, HADS-Anxiety, HADS-Depression, DAPSA, DAS28-CRP, BASDAI, BASFI, HAQ and HAQ-S scores of the obese group were higher than the non-obese group (p < 0.05). VAS-P and PASI scores were similar between group of patients with and without obesity. Obese patients had higher median scores of VAS-F and FACIT than non-obese patients (p < 0.05). Linear regression analysis showed that BMI affects the quality of life, depression, and disease activity. Consequently, obesity has significant associations with higher disease activity, lower QoL, risk of anxiety, depression, and fatigue. Therefore, obesity should also be taken into account in the management of PsA patients.
Inconsistencies of the Disease Activity Assessment Tools for Psoriatic Arthritis: Challenges to Rheumatologists
(Elsevier France-Editions Scientifiques Medicales Elsevier, 2022) Gezer, Halise Hande; Duruoz, Mehmet Tuncay; Nas, Kemal; Kilic, Erkan; Sargin, Betul; Kasman, Sevtap Acer; Alkan, Hakan
Objective: Currently, concerning the evaluation of psoriatic arthritis (PsA), there is no agreement on a standardized composite index for disease activity that includes all relevant domains. The present study sought to assess the rates of remission (REM)/low disease activity (LDA) and disease states [minimal disease activity (MDA), very low disease activity (VLDA)] as defined by diverse activity scales (DAPSA, DAS28-ESR) in an attempt to display discrepancies across these assessment tools for peripheral PsA. Methods: The study involved 758 patients (496 females, 262 males; mean age 47,1 years) with peripheral PsA who were registered to the Turkish League Against Rheumatism (TLAR) Network. The patients were assessed using the DAS28-ESR, DAPSA, MDA, and VLDA. The overall yield of each scale was assessed in identifying REM and LDA. The presence or absence of swollen joints was separately analysed. Results: The median disease duration was 4 years (range 0-44 years). According to DAPSA and DAS28-ESR, REM was achieved in 6.9% and 19.5% of the patients, respectively. The rates of MDA and VLDA were 16% and 2.9%, respectively. Despite the absence of swollen joints, a significant portion of patients were not considered to be in REM (296 (39.1%) patients with DAS28-ESR, 364 (48%) with DAPSA, and 394 (52%) with VLDA). Conclusion: Patients with peripheral PsA may be assigned to diverse disease activity levels when assessed with the DAS28-ESR, DAPSA, MDA and VLDA, which would inevitably have clinical implications. In patients with PsA a holistic approach seems to be necessary which includes other domains apart from joint involvement, such as skin involvement, enthesitis, spinal involvement, and patient-reported outcomes. (C) 2021 Societe franc , aise de rhumatologie. Published by Elsevier Masson SAS. All rights reserved.
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.
POSSIBLE POTENTIAL INTERACTIONS BETWEEN OBESITY, QUALITY OF LIFE, PSYCHOLOGICAL STATUS AND CLINICAL PARAMETERS IN PSORIATIC ARTHRITIS
(Bmj Publishing Group, 2019) Gok, Kevser; Nas, Kemal; Kilic, Erkan; Sargin, Betul; Kasman, Sevtap Acer; Alkan, Hakan; Sahin, Nilay
[Abstract Not Availabe]
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.
Regional Difference in Disease Burden Among Patients with Psoriatic Arthritis: A Multi-Center Study
(Wiley, 2019) Kilic, Erkan; Kilic, Gamze; Nas, Kemal; Sargin, Betul; Kasman, Sevtap Acer; Alkan, Hakan; Sahin, Nilay
[Abstract Not Availabe]
The Relationship Between Fatigue and Disease Activity as Determined by Different Indices in Patients with Psoriatic Arthritis (PsA)
(Wiley, 2019) Duruoz, Mehmet Tuncay; Gezer, Halise Hande; Nas, Kemal; Kilic, Erkan; Sargin, Betul; Kasman, Sevtap Acer; Alkan, Hakan
[Abstract Not Availabe]
THE RISK FACTORS RELATED TO MENTAL HEALTH PROBLEMS IN PATIENTS WITH PSORIATIC ARTHRITIS IN A LARGE MULTICENTER STUDY; DATA FROM TLAR-NETWORK
(Bmj Publishing Group, 2019) Kilic, Gamze; Nas, Kemal; Kilic, Erkan; Tekeoglu, Ibrahim; Sargin, Betul; Kasman, Sevtap Acer; Alkan, Hakan
[Abstract Not Availabe]
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.
Turkish League Against Rheumatism (TLAR) Recommendations for the Pharmacological Management of Rheumatoid Arthritis: 2018 Update Under Guidance of Current Recommendations
(2018) Ataman, Şebnem; Kocabaş Ecesoy, Hilal; Yılmaz, Gürkan; Bodur, Hatice; Nas, Kemal; Ayhan, Fikriye Figen
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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