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Öğe Anti-interleukin-1 treatment in 26 patients with refractory familial mediterranean fever(Springer, 2017) Kucuksahin, Orhan; Yildizgoren, Mustafa Turgut; Ilgen, Ufuk; Ates, Askin; Kinikli, Gulay; Turgay, Murat; Erten, SukranObjective: To investigate the effect of anti-interleukin-1 (anti-IL-1) treatment on the frequency and severity of attacks and other disease-related clinical parameters and to evaluate the adverse effects associated with anti-IL-1 treatment in 26 patients with refractory familial mediterranean fever (FMF).Methods: The study included 26 FMF patients followed up in our centre using colchicine for 4 months to 30 years. The treatment was switched to anti-IL-1 treatment for various reasons; 20 cases were resistant to colchicine, 8 were intolerant to colchicine, and 3 had prolonged arthritis under colchicine. Clinical response was monitored through the number of attacks, and laboratory inflammation was monitored through erythrocyte sedimentation rate, C-reactive protein, and serum amyloid A concentrations. Colchicine resistance was defined as at least two attacks/month together with C-reactive protein and serum amyloid A levels above the normal range between attacks. The colchicine dose was increased to 2mg/day before they were considered colchicine-resistant.Results: 24 patients used anakinra (100mg/day), and 2 used canakinumab (150mg/month), for -36 months. Sixteen patients with colchicine resistance had no attacks under anti-IL-1 treatment, and 4 had decreased frequency and duration of attacks. Seven of 8 patients intolerant to colchicine used anakinra, and 6 were attack-free under treatment, while 1 using canakinumab had attacks under treatment. One patient with prolonged arthritis used canakinumab but arthritis showed progression and the treatment was changed to IL-6 inhibitor. Three patients had injection site erythema and one had fatigue with anti-IL-1 treatment. Topical steroids with systemic antihistaminics were sufficient for symptom control in two cases, but canakinumab treatment was given due to severe injection site erythema in one case.Conclusion: Anti-IL-1 agents are rational treatment modalities in patients resistant or intolerant to colchicine. Anti-IL-1 agents can control FMF attacks quite effectively and they have a promising role in the treatment of FMF.Öğe Are There Any Clues to Predict Bamboo Spine in Axial Spondyloarthritis?(Wiley, 2020) Atagunduz, Pamir; Kiraz, Sedat; Akar, Servet; Kucuksahin, Orhan; Erden, Abdulsamet; Coskun, Nihan; Yagiz, Burcu[Abstract Not Available]Öğe Association of serum KL-6 levels with interstitial lung disease in patients with connective tissue disease: a cross-sectional study(Springer London Ltd, 2016) Oguz, Ekin Oktay; Kucuksahin, Orhan; Turgay, Murat; Yildizgoren, Mustafa Turgut; Ates, Askin; Demir, Nalan; Kumbasar, Ozlem OzdemirIt was aimed to evaluate KL-6 glycoprotein levels to determine if it may be a diagnostic marker for the connective tissue diseases (CTDs) predicting CTD-related interstitial lung diseases (ILDs) (CTD-ILD) development and to examine if there was a difference between patients and healthy controls. The study included 113 patients with CTD (45 CTD without lung involvement, 68 CTD-ILD) and 45 healthy control subjects. KL-6 glycoprotein levels were analyzed with ELISA in patients and the control group. The relationship between KL-6 glycoprotein levels and CTD-ILD was assessed. In the comparison of all the groups in the study, significantly higher levels of KL-6 were determined in the CTD-ILD group than in either the CTD without pulmonary involvement group or the healthy control group (p < 0.008 and p < 0.001, respectively). There was no statistically significant difference between the KL-6 levels in the healthy control group and the CTD without pulmonary involvement group (p = 0.289). The KL-6 levels did not differ significantly according to the connective tissue diseases in the diagnostic groups (systemic lupus erythematosus, Sjogren's syndrome, rheumatoid arthritis, mixed connective tissue disease, scleroderma, polymyositis/ dermatomyositis). In the healthy control group, there was a statistically significant difference between KL-6 levels in smokers and non-smokers. Smokers had significantly higher serum KL-6 levels compared with non-smokers (p < 0.05). There was no statistically significant difference between smoking status (pack-year) and serum KL-6 levels. There was no statistically significant correlation between serum KL-6 levels and time since diagnosis of CTD and CTD-ILD. The level of KL-6 as a predictive factor could be used to identify the clinical development of ILD before it is detected on imaging modality. Further prospective clinical studies are needed to define whether levels of KL-6 might have prognostic value or might predict progressive ILD.Öğe Bosentan For Digital Ulcers in Patients With Systemic Sclerosis: Single Center Experience(Turkish League Against Rheumatism, 2016) Kucuksahin, Orhan; Yildizgoren, Mustafa Turgut; Gerede, Demet Menekse; Maras, Yuksel; Erten, SukranObjectives: This study aims to investigate the effects of bosentan on the prevention and treatment of digital ulcers in systemic sclerosis (SSc) patients. Patients and methods: The study included 30 patients (4 males, 26 females; mean age 49.6 +/- 15.4 years; range 23 to 71 years) diagnosed with SSc and treated with bosentan for digital ulcers. Bosentan was administered to all patients for a mean of 14 +/- 10.3 months. All SSc cases were refractory to calcium channel antagonists or angiotensin II inhibitors. The diagnosis of SSc was based on the American College of Rheumatology criteria and patients were classified as limited or diffuse cutaneous SSc according to the LeRoy classification. Results: Mean disease duration was 8.8 +/- 8.0 years and mean duration of digital ulcers was 29.4 +/- 6.6 months. Under the bosentan treatment, eight patients (26.7%) developed new digital ulcers; all of these patients had diffuse cutaneous SSc. Health Assessment Questionnaire scores improved after 12 months and 24 months of treatment (p<0.001). Three patients (10%) developed pulmonary arterial hypertension under bosentan treatment [ two patients (6.6%) had SSc-associated pulmonary arterial hypertension and one patient (3.3%) had interstitial fibrosis-associated pulmonary arterial hypertension]. The anti-centromere antibody positive patients were predominantly classified as limited cutaneous SSc. Of the patients positive for anti-topoisomerase-1 antibodies, a high proportion was classified as diffuse cutaneous SSc. Pulmonary fibrosis was most frequent in the anti-topoisomerase-1 antibody subset. New digital ulcers developed mainly in the anti-topoisomerase-1 antibody positive patients. Conclusion: Bosentan may be used either alone or in combination with other treatments when digital ulcers worsen and may be expected to suppress the development of new ulcers and severe pain. Further preclinical studies are required shedding light on the etiopathogenesis of SSc and larger clinical trials are needed for more definitive treatment strategies.Öğe Corticosteroid Utilization before and after Initiation of Biologic Dmards between Patients with Rheumatoid Arthritis(Wiley, 2018) Yagiz, Burcu; Coskun, Belkis Nihan; Kiraz, Sedat; Ertenli, Ihsan; Kucuksahin, Orhan; Dalkilic, Ediz; Bes, Cemal[Abstract Not Available]Öğe Factors That May be Associated with Uveitis in Patients with Spondyloarthritis(Wiley, 2018) Kasifoglu, Timucin; Bilge, Nazife Sule Yasar; Kiraz, Sedat; Ertenli, Ihsan; Kucuksahin, Orhan; Dalkilic, Ediz; Bes, Cemal[Abstract Not Available]Öğe In the era of disease-modifying antirheumatic drugs, how close are we to treating rheumatoid arthritis without the use of glucocorticoids?(Springer Heidelberg, 2021) Yagiz, Burcu; Coskun, Belkis Nihan; Pehlivan, Yavuz; Dalkilic, Ediz; Kiraz, Sedat; Yazisiz, Veli; Kucuksahin, OrhanWe wanted to see how close we could get to our goal of treating rheumatoid arthritis (RA) without the use of glucocorticoids (GCs) in the disease-modifying antirheumatic drugs (DMARDs) era using real-life data. Established in 2017, the TReasure database is a web-based, prospective, observational cohort for Turkey. As of May 2019, there were 2,690 RA patients recorded as receiving biologic and targeted synthetic DMARDs (bDMARDs and tsDMARDs) therapy. At the start of the bDMARDs or tsDMARDs, patients with follow-up visits of at least 3 months were registered. At the time of registration and the last visit, doses of GCs were recorded and it was determined if the target dose of <= 7.5 mg was achieved. During registration and follow-up, 23.4% of the patients did not receive GCs and 76.5% of the patients received GCs at any time. GCs could be stopped after 59 (25-116) months in 28.4% of these patients, but 71.6% of patients were still using GC. The target GC dose could not be achieved in 18.2% of these patients (n = 352). The rate of continuing to use GC was significantly higher in women, in the elderly, those with rheumatoid factor (RF) positive, with higher Visual Analog Scale (VAS) pain and Disease Activity Score (DAS)-28. The initial GC dose of >= 7.5 mg/day was found to be crucial in not reaching the GC target dose (p < 0.001, OR 39.0 (24.1-63.2)). The initial GC dose of >= 7.5 mg/day, female gender, age, RF positivity, high DAS28, and VAS pain level were all highly related for GC continuation. Despite the use of DMARDs, our data revealed that we are still far from achieving our goal of treating RA without using steroids.Öğe Large Joint and Lower Extremity Involvement Has Higher Impact on Disease Outcomes in Oligoarticular PsA(Wiley, 2019) Ayan, Gizem; Solmaz, Dilek; Bakirci, Sibel; Tinazzi, Ilaria; Omma, Ahmet; Kucuksahin, Orhan; Ozisler, Cem[Abstract Not Available]Öğe Large joint and lower extremity involvement have higher impact on disease outcomes in oligoarticular psoriatic arthritis(Wiley, 2020) Ayan, Gizem; Solmaz, Dilek; Bakirci, Sibel; Tinazzi, Ilaria; Omma, Ahmet; Kucuksahin, Orhan; Ozisler, CemObjective Joints with different sizes and anatomical locations can be affected in psoriatic arthritis (PsA). Our aim was to explore the effect of different joint patterns on patient-reported outcomes (PROs) in patients with mono-oligoarthritis. Methods Within PsArt-ID (Psoriatic Arthritis- International Database), 387/1670 patients who had mono-oligoarthritis (1-4 tender and swollen joints) were enrolled in cross-sectional assessment. The joints were categorized according to their size (small/large) and location (upper/lower extremity) and PROs, physician global assessment and C-reactive protein (CRP) were compared. Analysis was made by categorizing according to joint counts (1-2 joints/ 3-4 joints). Results The mean age (SD) was 46.9 (14.24) with a mean (SD) PsA duration of 3.93 (6.03) years. Within patients with 1-2 involved joints (n = 302), size of the joints only had an impact on CRP values with large joints having higher CRP (P = .005), similar to lower extremity involvement (P = .004). PROs were similar regardless of size or location if 1-2 joints were inflamed. Within patients with 3-4 involved joints (n = 85), patient global assessment (PGA), pain, fatigue and physician global assessment were higher in the group with large joints. Similarly, PGA, pain, and physician global assessment were higher in patients with lower extremity involvement as well as higher CRP values. Conclusion For PsA patients with 3-4 joints involved, lower extremity and large joints are associated with poorer outcomes with worse PROs, physician global assessment, and higher CRP. The size and anatomical location of the joints are less important for patients with 1-2 joints in terms of the PROs.Öğe Leflunomide As a Concomitant DMARD Choice for the Biological Treatment Era of Rheumatoid Arthritis(Wiley, 2018) Kimyon, Gezmis; Kiraz, Sedat; Ertenli, Ihsan; Kucuksahin, Orhan; Dalkilic, Ediz; Bes, Cemal; Kanitez, Nilufer Alpay[Abstract Not Available]Öğe Methodology of a new inflammatory arthritis registry: TReasure(Tubitak Scientific & Technological Research Council Turkey, 2018) Kalyoncu, Umut; Tascilar, Etem Koray; Ertenli, Ali Ihsan; Dalkilic, Huseyin Ediz; Bes, Cemal; Kucuksahin, Orhan; Kasifoglu, TimucinBackground/aim: The TReasure registry, created in 2017, is an observational multicenter cohort that includes inflammatory arthritis patients. This article reviews the methodology and objectives of the TReasure registry established to collect data from rheumatoid arthritis (RA) and spondyloarthritis (SpA) patients. Methodology: Fifteen rheumatology centers in Turkey will contribute data to the TReasure database. The actual proprietor of the database is the Hacettepe Rheumatology Association (HRD) and Hacettepe Financial Enterprises. Pharmaceutical companies that operate in Turkey (in alphabetical or er), Abbvie, Amgen, BMS, Celltrion Healthcare, Novartis, Pfizer, Roche, and UCB, support the TReasure registry. TReasure is a web-based database to which users connect through a URL (https://www.trials-network.org/treasure) with their unique identifier and passwords provided for data entry and access. TReasure records demographic and clinical features, comorbidities, radiology and laboratory results, measures of disease activity, and treatment data. Discussion: TReasure will provide us with various types of data, such as a cross-sectional view of the current nationwide status of the patients currently receiving these treatments, and retrospective data as much as allowed by the participating centers' records. Finally, a high-quality prospective dataset will be built over the ensuing years from patients with a new diagnosis of RA or SpA.Öğe SMOKING MAY BE RELATED TO SACROILIITIS IN ENTEROPATHIC ARTHRITIS PATIENTS: TREASURE REAL-LIFE PRELIMINARY DATA(Bmj Publishing Group, 2019) Kucuksahin, Orhan; Erden, Abdulsamet; Ilgen, Ufuk; Kiraz, Sedat; Ertenli, Ali Ihsan; Bilge, Nazife Sule Yasar; Kasifoglu, Timucin[Abstract Not Available]Öğe Tuberculin skin test before biologic and targeted therapies: does the same rule apply for all?(Springer Heidelberg, 2022) Ilgen, Ufuk; Karadag, Omer; Emmungil, Hakan; Kucuksahin, Orhan; Koca, Suleyman Serdar; Erden, Abdulsamet; Bes, CemalThis study aimed to compare Tuberculin Skin Test (TST) and QuantiFERON (R)-TB Gold In-Tube (QFT-GIT) test in rheumatoid arthritis (RA) and spondyloarthritis (SpA) patients scheduled for biological and targeted synthetic disease modifying anti-rheumatic drugs (DMARDs) in a Bacillus Calmette-Guerin-vaccinated population. Adult RA (n = 206) and SpA (n = 392) patients from the TReasure database who had both TST and QFT-GIT prior to initiation of biological and targeted synthetic DMARDs were included in the study. Demographic and disease characteristics along with pre-biologic DMARD and steroid use were recorded. The distribution of TST and performance with respect to QFT-GIT were compared between RA and SpA groups. Pre-biologic conventional DMARD and steroid use was higher in the RA group. TST positivity rates were 44.2% in RA and 69.1% in SpA for a 5 mm cutoff (p < 0.001). Only 8.9% and 15% of the patients with RA and SpA, respectively, tested positive by QFT-GIT. The two tests poorly agreed in both groups at a TST cutoff of 5 mm and increasing the TST cutoff only slightly increased the agreement. Among age, sex, education and smoking status, pre-biologic steroid and conventional DMARD use, disease group, and QFT-GIT positivity, which were associated with a 5 mm or higher TST, only disease group (SpA) and QFT-GIT positivity remained significant in multiple logistic regression. TST positivity was more pronounced in SpA compared to that in RA and this was not explainable by pre-biologic DMARD and steroid use. The agreement of TST with QFT-GIT was poor in both groups. Using a 5 mm TST cutoff for both diseases could result in overestimating LTBI in SpA.Öğe Uveitis-related Factors in Patients With Spondyloarthritis: TReasure Real-Life Results(Elsevier Science Inc, 2021) Bilge, Nazife Sule Yasar; Kalyoncu, Umut; Atagunduz, Pamir; Dalkilic, Ediz; Pehlivan, Yavuz; Kucuksahin, Orhan; Bes, CemalPURPOSE: Spondyloarthritis (SpA) is a group of diseases with overlapping skeletal and extra-articular features. Acute anterior uveitis (AAU) is the most common extra-articular manifestation of SpA. The relation between AAU and SpA is well defined in the current literature. Our study aims to analyze the frequency and factors associated with AAU in different forms of SpA in a large nationwide cohort of Turkish SpA patients. DESIGN: Retrospective cohort study. METHODS: The data were obtained from the TReasure database, which compiles data from records of the web-based Rheumatoid Arthritis (RA) and SpA patients treated with biological disease-modifying anti-rheumatismal drugs from different regions of Turkey. The clinical characteristics of SpA and uveitis are recorded. RESULTS: Data of the 4,297 SpA patients were included in the study. Overall, 475 of 4,297 patients (11.0%) had experienced 1 or more episodes of uveitis. SpA patients with older age (P<.001), a smoking history (P=.004), delayed diagnosis (P=.001), longer disease duration (P<.001), arthritis (P<.001), positive HLA-B27 (P<.001), a family history of SpA (P<.001), and radiographic damage (presence of sacroiliitis, syndesmophytes, bamboo spine, hip involvement) (P<.001 for all) more commonly had uveitis. On the other hand, uveitis was less prevalent in patients with psoriasis and psoriatic arthritis (P<.001 for both). CONCLUSION: Uveitis may be the key feature leading to SpA diagnosis. Patients with radiographic damage and long disease duration have an increased risk for uveitis in both male and female SpA patients. Patients with uveitis should be referred to a rheumatologist for a thorough evaluation of SpA. ((C) 2021 Elsevier Inc. All rights reserved.)
