Publications by authors named "Abdulsamet Erden"

106 Publications

Can anticarbamylated protein antibodies be used to support the diagnosis of systemic lupus erythematosus?

Biomark Med 2021 Sep 7. Epub 2021 Sep 7.

Yıldırım Beyazıt University, Ankara City Hospital, Department of Internal Medicine, Division of Rheumatology, Ankara, Turkey.

Autoantibody development plays an important role in the pathogenesis of systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA). In this study, we aimed to determine the diagnostic value of anticarbamylated protein antibody (anti-CarP) antibody in SLE and RA patients and its relationship with disease prognosis. Fifty-seven SLE patients (F/M 50/7; median age 40.9 ± 13.7; median disease duration 2 years) who met the 2012 SLICC SLE diagnostic criteria were included in the study. A total of 46 RA patients selected according to the 2010 ACR/EULAR diagnostic criteria (F/M 38/8; median age 54.2 ± 12.4; median disease duration 2 years) were included. A total of 30 healthy individuals were selected as the control group. The anti-CarP antibody was studied by using human anticarbamylated protein antibody ELISA Kit (SunRedBio, Shanghai, China). Anti-CarP antibody positivity was found to be 17.4% in RA patients (p < 0.001), 54.4% in SLE patients (p < 0.001) and 3.3% in the healthy control group. The anti-CarP antibody was determined to predict SLE patients with 54.4% sensitivity and 96.7% specificity compared with the healthy control group (area under the curve: 0.755; p < 0.001). Anti-CarP antibody positivity was significantly higher in the SLE patients compared with the healthy control and RA group. It has significant sensitivity and specificity in both SLE and RA patients compared with the healthy controls.
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http://dx.doi.org/10.2217/bmm-2021-0037DOI Listing
September 2021

Should timing be considered before abandoning convalescent plasma in covid-19? Results from the Turkish experience.

Transfus Apher Sci 2021 Aug 10:103238. Epub 2021 Aug 10.

Yıldırım Beyazıt University, School of Medicine, Department of Internal Medicine, Division of Rheumatology, Ankara, Turkey.

Introductions: Results with convalescent plasma therapy in coronavirus disease 2019 (COVID-19) have been contradictory. Timing seems to be an important factor for COVID-19 convalescent plasma(CCP) to be effective. Aim of this study is to compare disease outcomes in hospitalized COVID-19 patients who were treated with CCP within first three or seven days of symptoms to patients with symptoms longer than seven days.

Material And Methods: A multicenter retrospective study was conducted to evaluate disease outcomes in hospitalized COVID-19 patients who received CCP in addition to standard of care (SOC) approach. Patients were subgrouped according to time of CCP administration; within three days of symptoms, seven days of symptoms and after seven days of symptoms. A control group was formed from age, gender and comorbidity matched hospitalized patients who received SOC treatments without CCP. Length of hospital stay, rates of anti-inflammatory treatment initiation, intensive care unit (ICU) admission and mortality was set as outcome measures.

Results: A total of 223 patients were enrolled in this study, 113 patients received CCP (38 within three days, 63 within seven days, 50 after seven days of symptom onset). Rate of anti-inflammatory treatment initiation was significantly lower (38.1 % vs 62.7 %, p = 0.002, relative risk, 0.60,73; 95 % confidence interval [CI], 0.42 to 0.85) and length of hospital stay was significantly shorter (median(IQR) 8(4) days vs 9.5(5.25) days, p = 0.0025) in patients who received CCP within seven days of symptom onset when compared to SOC group.

Conclusion: CCP therapy may provide better outcomes when applied within seven days of symptoms.
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http://dx.doi.org/10.1016/j.transci.2021.103238DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8353966PMC
August 2021

Budd-Chiari syndrome in Behçet's disease: a retrospective multicenter study.

Clin Rheumatol 2021 Aug 9. Epub 2021 Aug 9.

Department of Internal Medicine, Division of Rheumatology, Ege University School of Medicine, İzmir, Turkey.

Objective: To compare the clinical features, laboratory findings, and prognosis of Behçet's disease (BD) patients with and without Budd-Chiari syndrome (BCS).

Methods: This multicenter retrospective study investigated 61 (M/F: 41/20) patients with BD, having coexistent BCS, and 169 (M/F:100/69) BD patients as the control group without BCS from 22 different centers of Turkey diagnosed between 1990 and 2017.

Results: Of the total 61 BD patients with BCS, the onset of the first symptom and the median age of diagnosis were earlier in contrast to BD patients without BCS (p = 0.005 and p = 0.007). Lower extremity deep vein and inferior vena cava (IVC) thrombosis were more common in patients with BCS (all; p < 0.01) compared to the control group. Mortality was significantly higher in BD-BCS patients with IVC thrombosis than in the controls (p = 0.004). Since most of the cases in our cohort had chronic and silent form of BCS, mortality rate was 14.8%, which was on the lower range of mortality rate reported in literature (14-47%). While all BD-BCS patients received immunosuppressive (IS) agents, only half of them received additional anticoagulant treatments. Among IS agents, interferon treatment was more frequently used in this cohort (19%), compared to other series reported in literature (2.3%).

Conclusion: To our knowledge, this is the largest series of BD patients with BCS. Our patients had earlier disease onset and diagnosis, higher frequency of IVC thrombosis, and higher mortality rate, compared to BD patients without BCS. Mortality was significantly higher in BD-BCS patients with IVC thrombosis compared to controls. Key Points • Mortality rate is higher in BD-associated BCS patients with IVC involvement. • Chronic and silent form of BD-associated BCS has a better prognosis. • The main treatment options are corticosteroids and immunosuppressive agents, whereas anticoagulant treatment remains controversial.
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http://dx.doi.org/10.1007/s10067-021-05878-2DOI Listing
August 2021

Compliance to not only prone but also lateral and supine positioning improves outcome in hospitalised COVID-19 patients.

Int J Clin Pract 2021 Jul 29:e14673. Epub 2021 Jul 29.

Division of Rheumatology, Department of Internal Medicine, Ministry of Health Ankara City Hospital, Ankara, Turkey.

Background: Positioning of the patient is a common strategy to increase oxygenation in the management of acute respiratory distress syndrome. The aim of this study is to demonstrate the effects of our positioning approach on disease outcomes in COVID-19 patients with respiratory failure, by comparing patients compliant to positioning and not.

Methods: COVID-19 patients who were admitted to our internal medicine inpatient clinic and developed hypoxaemia and underwent positioning during hospital stay were retrospectively investigated for compliance to positioning. Rates of mortality, intensive care unit admission, intubation, initiation of anti-inflammatory treatment and length of hospital stay were compared between patients with and without compliance to positioning.

Results: A total of 144 patients were enrolled in this study (97 compliant with positioning, 47 incompliant with positioning). Rates of ICU admission (7.2% vs 25.5%, p < .001), anti-inflammatory treatment initiation (68% vs 97.9%, p < .001) and length of hospital stay (5 (2-16) days vs 12 (3-20) days, p < .001) were significantly reduced in patients compliant with positioning.

Conclusion: Prone or other positioning should be considered in patients with noninvasive oxygen support for the potential to reduce rates of intensive care unit admissions, airway interventions, anti-inflammatory treatment initiation and mortality.
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http://dx.doi.org/10.1111/ijcp.14673DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8420268PMC
July 2021

Convalescent Plasma Reduces Endogenous Antibody Response in COVID-19: A Retrospective Cross-Sectional Study.

Turk J Haematol 2021 Jul 26. Epub 2021 Jul 26.

Yıldırım Bayezıt University, School of Medicine, Department of Internal Medicine, Division of Rheumatology, Ankara, Turkey.

Objective: Aim of this study is to investigate post-COVID-19 antibody titers in patients who received convalescent plasma (CP) in addition to standard of care.

Materials And Methods: Hospitalized COVID-19 patients who received CP in addition to standard of care were retrospectively investigated. Patients who received CP with a recorded total COVID-19 antibody test result after treatment were included. From hospitalized COVID-19 patients who received standard of care with a recorded total COVID-19 antibody test result, an age, gender and comorbidity matched control group was formed. Total COVID-19 antibody index levels were compared.

Results: Thirty-three CP recipients were enrolled in the study. Control group was consisted of 34 age, gender and comorbidity matched standard of care patients. Median(IQR) total COVID-19 antibody index levels were significantly reduced in CP group.

Conclusions: Although CP therapy may have benefits on the disease outcome, having a potential to hamper long-term immunity may be a problem.
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http://dx.doi.org/10.4274/tjh.galenos.2021.2021.0277DOI Listing
July 2021

In the era of disease-modifying antirheumatic drugs, how close are we to treating rheumatoid arthritis without the use of glucocorticoids?

Rheumatol Int 2021 Jul 5. Epub 2021 Jul 5.

Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey.

We 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.
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http://dx.doi.org/10.1007/s00296-021-04939-8DOI Listing
July 2021

Prevalence of sarcopenia and clinical implications in patients with newly diagnosed rheumatoid arthritis.

Nutrition 2021 May 26;90:111353. Epub 2021 May 26.

Yıldırım Bayezıt University, School of Medicine, Department of Internal Medicine, Ankara, Turkey.

Objective: The aim of this study was to determine the frequency of sarcopenia at the time of diagnosis in patients with rheumatoid arthritis (RA), assessing disease activity and factors that may be associated with sarcopenia and observe effects of treatment on sarcopenia.

Method: A prospective study was conducted with patients who have newly diagnosed RA. Patients were evaluated twice, at the time of diagnosis and 3 mo after the initiation of treatment. Demographic data, anthropometric measurements, disease activity scores, and sarcopenia status were recorded. Sarcopenia was evaluated with grip strength and bioelectric impedance. The results were compared with healthy volunteers.

Results: The age at onset of RA was 50.6 ± 14.6 y. Handgrip strength (P < 0.001), skeletal muscle mass (P = 0.009), and skeletal muscle mass index (P = 0.032) were reduced in patients with RA but not in the control group. The frequency of sarcopenia in RA at onset of diagnosis was 31.5%. There was a significant decrease in the rate of sarcopenia after 3 mo of treatment (31.5 versus 8.7%; P = 0.046).

Conclusion: Sarcopenia was found in approximately one-third of the patients with newly diagnosed RA in our study. With treatment, sarcopenia improved significantly. Patients with RA should be evaluated in terms of sarcopenia in addition to evaluating joint and extraarticular findings at the time of diagnosis. Early detection and treatment planning may improve quality of life.
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http://dx.doi.org/10.1016/j.nut.2021.111353DOI Listing
May 2021

A single center experience of intravenous immunoglobulin treatment in Covid-19.

Int Immunopharmacol 2021 Sep 14;98:107891. Epub 2021 Jun 14.

Yıldırım Beyazıt University, School of Medicine, Department of Internal Medicine, Division of Rheumatology, Ankara 06800, Turkey.

Background: Intravenous immunoglobulins (IVIg) have been used in management of severe Covid-19. Here in this study, we report our single-center experience regarding IVIg treatment in management of severe Covid-19.

Materials And Method: Among hospitalized adult Covid-19 patients between April 1 and December 31, 2020, patients with confirmed diagnosis of Covid-19 who had Brescia-COVID respiratory severity scale score ≥ 3, hyperinflammation and received IVIg treatment in addition to standard of care were retrospectively investigated. We grouped IVIg recipients into three according to reasons for IVIg administration: Group 1 patients requiring anti-inflammatory treatment but complicated with secondary infection and/or sepsis , group 2 patients with Covid-19 related complications including progressive disease refractory to other anti-inflammatory agents, myocarditis, adult multisystem inflammatory syndrome, hemophagocytic lymphohystiocytosis like syndrome and group 3 patients with other complications non-specific to Covid-19. Mortality and clinical data was compared among groups.

Results: A total of 46 IVIg recipients were enrolled. Group 1 comprised 17 (36.9%), group 2 comprised 18 (39.1%) and group 3 comprised 11 (23.9%) patients. No significant differences in means of age, gender and comorbidities were observed among groups. Mortality was significantly lower in group 3 when compared to group 1 (64.7% vs 18.2%, p = 0.016) and close to significance when compared to group 2 (50% vs 18.2% p = 0.087).

Conclusions: IVIg seemed to be used mostly in severe, refractory and complicated cases in our population. As a rescue agent in severe cases refractory to other anti-inflammatory strategies, 33.7% survival rate was observed with IVIg.
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http://dx.doi.org/10.1016/j.intimp.2021.107891DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8200303PMC
September 2021

COVID-19 and eosinophilic granulomatosis with polyangiitis or COVID-19 mimicking eosinophilic granulomatosis with polyangiitis?

Rheumatol Int 2021 08 25;41(8):1515-1521. Epub 2021 May 25.

Division of Rheumatology, Department of Internal Medicine, Ankara City Hospital, Ankara, 06100, Turkey.

Coronavirus disease 2019 (COVID-19) and eosinophilic granulomatosis with polyangiitis (EGPA) share similarities in clinical, imaging findings and may present with respiratory distress. Differentiating a new-onset EGPA from COVID-19 during the current pandemic is a diagnostic challenge, particularly if other EGPA symptoms are overlooked. Here in this study we reviewed the literature regarding EGPA patients with COVID-19 and patients who diagnosed with EGPA or suffered an EGPA flare mimicking COVID-19. We conducted a literature survey in PUBMED database using meshed keywords "COVID-19" and "EGPA", "COVID-19" and "eosinophilic granulomatosis with polyangiitis", "COVID-19" and "Churg Strauss Syndrome", to reveal previously reported cases involving EGPA patients who had COVID-19 infection, patients who suspected to have COVID-19 but eventually diagnosed with EGPA and patients with a known diagnosis of EGPA who suffered a flare but a COVID-19 infection was suspected initially. A total of 11 cases (6 literature cases, 5 cases from our clinic) were included in our study. Seven (63.6%) of the cases were defined as COVID-19 mimicker and 4 (36.4%) were EGPA with COVID-19. All of the cases in EGPA with COVID-19 group had a history of asthma. All of them had a positive PCR result and ground-glass opacities in thorax CT. In COVID-19 mimicker group, six (85.7%) patients had a history of asthma and other EGPA features that were observed were eosinophilia in 6 (85.7%). Our study provided clues regarding the EGPA/COVID-19 diagnostic challenge which may be useful in the current pandemic. Since none of the findings in COVID-19 are disease-specific, other conditions like EGPA should not be overlooked particularly in PCR negative patients and clinical, laboratory and imaging findings should be interpreted carefully. Furthermore, we did not observe poor outcomes in EGPA patients who had COVID-19.
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http://dx.doi.org/10.1007/s00296-021-04896-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8146171PMC
August 2021

Physicians' Biological Drug Preference in Patients With Rheumatoid Arthritis and Spondyloarthritis With a History of Malignancy: Perspectives From the Treasure Database.

J Clin Rheumatol 2021 Jan 19. Epub 2021 Jan 19.

From the *Division of Rheumatology, Department of Internal Medicine, University of Health Sciences, Gulhane Faculty of Medicine †Division of Rheumatology, Department of Internal Medicine, Hacettepe University Faculty of Medicine ‡Division of Rheumatology, Department of Internal Medicine, Ankara Yıldırım Beyazıt University Faculty of Medicine, Ankara §Division of Rheumatology, Department of Internal Medicine, Eskisehir Osmangazi University Faculty of Medicine, Eskisehir ∥Division of Rheumatology, Department of Internal Medicine, University of Health Sciences, Bakırkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul ¶Division of Rheumatology, Department of Internal Medicine, Uludag University Faculty of Medicine, Bursa #Division of Rheumatology, Department of Internal Medicine, Ankara City Hospital, Ankara **Division of Rheumatology, Department of Internal Medicine, Koc University Faculty of Medicine, Istanbul ††Division of Rheumatology, Department of Internal Medicine, Izmir Katip Celebi University Faculty of Medicine, Izmir ‡‡Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Tekirdag Namık Kemal University, Tekirdag §§Division of Rheumatology, Department of Internal Medicine, Akdeniz University Faculty of Medicine, Antalya ∥∥Division of Rheumatology, Department of Internal Medicine, Marmara University Faculty of Medicine, Istanbul, Turkey.

Objective: Because of concerns about malignancy risks, using biological disease-modifying antirheumatic drugs (bDMARDs) in patients with a history of malignancy remains a challenging issue in rheumatology practice. This study aimed to investigate bDMARD preferences of physicians when treating of rheumatoid arthritis (RA) and spondyloarthritis (SpA) patients with a history of malignancy.

Methods: The data for this cross-sectional study were gathered from the TReasure database using a date range of December 2017 and January 2020. Biological disease-modifying antirheumatic drug preferences were analyzed for 40 RA patients and 25 SpA patients with a history of malignancy.

Results: The most frequently prescribed bDMARD was rituximab, which was given to 28 RA patients (70%). For 25 patients (62.5%), the time between the diagnosis of malignancy and starting on a bDMARD regimen was less than 60 months, with a median interval of 43.5 months. Among SpA patients, the preferred bDMARDs were secukinumab and etanercept, which were each administered to 7 patients (28%). For 13 SpA patients (52%), the time between the diagnosis of malignancy and starting on bDMARDs was less than 60 months, with a median interval of 97 months.

Conclusions: The observed bDMARD preferences may be related to the therapeutic effects of rituximab on lymphoproliferative malignancies, the protective effects of secukinumab on tumor progression, and the short half-life of etanercept. Biological disease-modifying antirheumatic drugs should be used in RA and SpA patients with malignancy in case of high inflammatory activity.
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http://dx.doi.org/10.1097/RHU.0000000000001699DOI Listing
January 2021

Comment on: What is the meaning of ANCA positivity in IgG4-related disease?

Rheumatology (Oxford) 2021 Sep;60(9):e344-e345

Department of Internal Medicine, Division of Rheumatology.

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http://dx.doi.org/10.1093/rheumatology/keab356DOI Listing
September 2021

Uveitis-related Factors in Patients With Spondyloarthritis: TReasure Real-Life Results.

Am J Ophthalmol 2021 Apr 4;228:58-64. Epub 2021 Apr 4.

From the Division of Rheumatology, Department of Internal Medicine, Eskisehir Osmangazi University, Eskisehir.

Purpose: Spondylarthritis (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 charecteristics 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.
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http://dx.doi.org/10.1016/j.ajo.2021.03.026DOI Listing
April 2021

Which hematological markers have predictive value as early indicators of severe COVID-19 cases in the emergency department?

Turk J Med Sci 2021 Mar 17. Epub 2021 Mar 17.

Background/aim: Coronavirus 2019 disease (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is a pandemic infectious disease that causes morbidity and mortality. As a result of high mortality rate among the severe COVID-19 patients, the early detection of the disease stage and early effective interventions are very important in reducing mortality. Hence, it is important to differentiate severe and non-severe cases from each other. To date, there are no proven diagnostic or prognostic parameters that can be used in this manner. Due to the expensive and not easily accessible tests that are performed for COVID-19, researchers are investigating some parameters that can be easily used. In some recent studies, hematological parameters have been evaluated to see if they can be used as predictive parameters.

Materials And Methods: In the current study, almost all hematological parameters were used, including the neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio, monocyte/lymphocyte ratio, mean platelet volume to lymphocyte ratio, mean platelet volume to platelet ratio, plateletcrit, and D-dimer/fibrinogen ratio (DFR), neutrophil/lymphocyte/platelet scoring system, and systemic immune-inflammation index. A total of 750 patients, who were admitted to Ankara City Hospital due to COVID-19, were evaluated in this study. The patients were classified into 2 groups according to their diagnosis (confirmed or probable) and into 2 groups according to the stage of the disease (non-severe or severe).

Results: The values of the combinations of inflammatory markers and other hematological parameters in all of the patients with severe COVID-19 were calculated, and the predicted values of these parameters were compared. According to results of the study, nearly all of the hematological parameters could be used as potential diagnostic biomarkers for subsequent analysis, because the area under the curve (AUC) was higher than 0.50, especially for the DFR and NLR, which had the highest AUC among the parameters.

Conclusion: Our findings indicate that, the parameters those enhanced from complete blood count, which is a simple laboratory test, can help to identify and classify COVID-19 patients into non-severe to severe groups.
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http://dx.doi.org/10.3906/sag-2008-6DOI Listing
March 2021

Predictors for the risk and severity of post-thrombotic syndrome in vascular Behçet's disease.

J Vasc Surg Venous Lymphat Disord 2021 Feb 20. Epub 2021 Feb 20.

Division of Rheumatology, Department of Internal Medicine, School of Medicine, Marmara University, Istanbul, Turkey.

Objective: Deep vein thrombosis (DVT) of the lower extremities is the most common form of vascular involvement in Behçet disease (BD), frequently leading to post-thrombotic syndrome (PTS) as a disabling complication. We have described the clinical characteristics and predictors of PTS presence among patients with BD and lower extremity DVT. We also used venous Doppler ultrasound (US) examinations in our assessment.

Methods: Patients with BD (n = 205; 166 men, 39 women; age 39 ± 9.5 years) and a history of DVT were investigated. The Villalta scale was used to assess the presence and severity of PTS. Doppler US examinations were performed within 1 week of the clinical evaluation. The total number of vessels with reflux, thrombi, recanalization, and collateral vessels were calculated.

Results: Of the 205 patients with BD, 62% had had PTS and 18% had had severe PTS. Patients with PTS had had greater reflux (P = .054) and thrombosis (P = .02) scores compared with patients without PTS. Treatment with anticoagulation (AC), immunosuppressive (IS) therapy, or AC combined with IS drugs did not affect the occurrence of PTS. However, patients treated with IS therapy, with or without AC drugs, had a decreased incidence of severe PTS compared with the AC-only group (P = .017). Patients treated with AC plus IS agents also had increased collateral scores compared with patients treated with only IS drugs. Interferon-α use seemed to provide better recanalization scores compared with azathioprine only (1.0 [range, 0-14] vs 2.5 [range, 0-10]; P = .010).

Conclusion: Patients with BD and DVT have a high risk of developing severe PTS. IS treatment decreases the development of severe PTS. AC therapy might influence the course of PTS by increasing the collateral scores, and the use of interferon-α also increased recanalization scores. Routine assessment with Doppler US examinations could be helpful in the prediction of severe PTS.
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http://dx.doi.org/10.1016/j.jvsv.2021.02.007DOI Listing
February 2021

COVID-19 outcomes in patients with familial Mediterranean fever: a retrospective cohort study.

Rheumatol Int 2021 04 21;41(4):715-719. Epub 2021 Feb 21.

Department of Internal Medicine, Division of Rheumatology, Ankara Yıldırım Bayezıt University Medical School, Ankara, Turkey.

Aim of this study is to investigate the course of coronavirus disease 2019 (COVID-19), in our cohort of familial Mediterranean fever (FMF) patients in means of mortality, admission to hospital and/or intensive care unit and length of hospital stay.A retrospective cohort was formed from patients who have previously been followed with a diagnosis of FMF. Patients of this cohort were retrospectively evaluated for a positive severe acute respiratory syndrome-coronavirus 2 (SARS-CoV 2) polymerized chain reaction (PCR) test result and information regarding hospitalisation, intensive care unit admission and mortality were collected from medical records.Out of a total 496 FMF patients, 34 were detected to have a positive SARS-CoV 2 PCR test. Eighty-five point three percent of these patients were under colchicine treatment and 17.6% were under interleukin (IL)-1 inhibitor treatment. Eight of the 34 patients (23.9%) were found to be hospitalized, one of them was admitted to the intensive care unit and died thereafter (2.9%). An increasing trend in the frequency of comorbid diseases (presence of at least one comorbidity 64.7% in all patients vs 75.0% in hospitalized patients) and IL-1 inhibitor usage (17.6% in all patients vs 50.0% in hospitalized patients) was observed in hospitalized patients.Rates of comorbid diseases and IL-1 inhibitor use for FMF were observed to be increased in FMF patients hospitalized for COVID-19.
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http://dx.doi.org/10.1007/s00296-021-04812-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7897358PMC
April 2021

False positivity of Rose Bengal test in patients with COVID-19: case series, uncontrolled longitudinal study.

Sao Paulo Med J 2020 Nov-Dec;138(6):561-562

MD. Professor, Department of Infectious Diseases and Clinical Microbiology, Ankara City Hospital, Ankara, Turkey.

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http://dx.doi.org/10.1590/1516-3180.2020.0484.03092020DOI Listing
December 2020

Imaging modalities used in diagnosis and follow-up of patients with Takayasu’s arteritis

Turk J Med Sci 2021 02 26;51(1):224-230. Epub 2021 Feb 26.

Department of Rheumatology, Faculty of Medicine, Hacettepe University, Ankara, Turkey

Background/aim: Takayasu’s arteritis (TA) is a rare, large-vessel vasculitis of unknown etiology, affecting aortic arch, and its main branches. Noninvasive imaging methods are frequently used in diagnosis and follow-up in Takayasu’s arteritis. Studies investigating optimal timing of follow up imaging are rare. This study is aimed to investigate the radiologic changes in vascular involvements of Takayasu’s arteritis patients one year after diagnosis.

Materials And Methods: Database of our Vasculitis Center was analyzed retrospectively and 97 patients were included into the study. Demographic, clinical, radiological, and therapeutic findings of patients were recorded. Patients with follow-up imaging after approximately one year of diagnosis were recruited into further analysis. Radiological changes and the effect of different immunosuppressive agents on vascular involvements were investigated.

Results: Mean age and disease duration of patients were 43.0 and 9.0 years. The most commonly used imaging methods/modalities for the diagnosis of TA were computer tomography-angiography (CT-Ang) (58.8%), magnetic resonance-angiography (MR-Ang) (29.9%), and doppler ultrasonography (11.3%). Subclavian and common carotid arteries were the most frequently involved vessels. Fifty-three patients underwent follow-up imaging after one year of diagnosis and, in 64% of patients, same imaging method had been used. MR- Ang (62.3%) and CT-Ang (35.9%) were the most preferred follow-up imaging studies. Sixty-eight percent of patients had stable vascular involvement, 28% had progression, and 4% had regression. No difference was found in radiological changes regarding patients with usage of different immunosuppressive agents (P = 0.634). There was no association between the change in serum acute phase reactants and radiological disease activity.

Conclusion: The most commonly used imaging modality for the diagnosis of TA was CT-Ang, whereas MR-Ang was the most preferred for follow-up. Almost 30% of TA patients in our Vasculitis Center had progression at around one year concordant with previous literature. A follow-up imaging at around one year of treatment seems feasible in management of TA.
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http://dx.doi.org/10.3906/sag-2005-70DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7991884PMC
February 2021

PsART-ID inception cohort: clinical characteristics, treatment choices and outcomes of patients with psoriatic arthritis.

Rheumatology (Oxford) 2021 04;60(4):1755-1762

Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Akdeniz University, Antalya, Turkey.

Objectives: Our aim is to understand clinical characteristics, real-life treatment strategies, outcomes of early PsA patients and determine the differences between the inception and established PsA cohorts.

Methods: PsArt-ID (Psoriatic Arthritis- International Database) is a multicentre registry. From that registry, patients with a diagnosis of PsA up to 6 months were classified as the inception cohort (n==388). Two periods were identified for the established cohort: Patients with PsA diagnosis within 5-10 years (n = 328), ≥10 years (n = 326). Demographic, clinical characteristics, treatment strategies, outcomes were determined for the inception cohort and compared with the established cohorts.

Results: The mean (s.d.) age of the inception cohort was 44.7 (13.3) and 167/388 (43.0%) of the patients were male. Polyarticular and mono-oligoarticular presentations were comparable in the inception and established cohorts. Axial involvement rate was higher in the cohort of patients with PsA ≥10 years compared with the inception cohort (34.8% vs 27.7%). As well as dactylitis and nail involvement (P = 0.004, P = 0.001 respectively). Both enthesitis, deformity rates were lower in the inception cohort. Overall, 13% of patients in the inception group had a deformity. MTX was the most commonly prescribed treatment for all cohorts with 10.7% of the early PsA patients were given anti-TNF agents after 16 months.

Conclusion: The real-life experience in PsA patients showed no significant differences in the disease pattern rates except for the axial involvement. The dactylitis, nail involvement rates had increased significantly after 10 years from the diagnosis and the enthesitis, deformity had an increasing trend over time.
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http://dx.doi.org/10.1093/rheumatology/keaa663DOI Listing
April 2021

QuantiFERON®-TB Gold In-Tube test can be used for screening latent tuberculosis before biological treatment in a Bacille Calmette-Guérin (BCG)-vaccinated country: the HUR-BIO single-center real-life results.

Clin Rheumatol 2021 May 15;40(5):2027-2035. Epub 2020 Oct 15.

Division of Rheumatology, Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey.

Objectives: The Turkish population is vaccinated with Bacille Calmette-Guérin (BCG), and the BCG vaccination decreases the specificity of the tuberculin skin test (TST). The purpose of this study was to investigate the incidence of active tuberculosis (TBC) among rheumatic patients who were screened only with the QuantiFERON®-TB Gold In-Tube (QFT-GIT) test for latent TBC prior to biological treatment.

Methods: The Hacettepe University Biological Database (HUR-BIO) was used for latent TBC assessment. Consecutive patients were evaluated from July 2015 to October 2016 by a questionnaire that included the patients' demographic characteristics, treatment history, and symptoms of active TBC. A total of 664 patients were interviewed by physicians. TBC statuses of the 671 non-interviewed patients were checked from the Turkish National Tuberculosis Registry records. Mean TBC incidence per year was calculated for anti-tumor necrosis factor-alpha (TNF-α) agents.

Results: A total of 1335 (58.2% female) patients with the mean age of 44.2 ± 12.9 years were included. Of the patients, 836 (62.6%) had spondyloarthropathy, 432 (32.4%) had rheumatoid arthritis, and 67 (5%) had other rheumatologic diseases. The total biological drug exposure was 2292 patient-years (2043 patient-years for anti-TNF-α, 249 patient-years for non-TNF-α inhibitors). Positive and indeterminate QFT-GIT results were found in 258 (19.3%) and 23 (1.7%) patients, respectively. The median follow-up time after the onset of biological agent was 19.4 months (IQR = 29.5). Pulmonary TBC was found in 3 (0.2%) of the 1335 patients. The annual incidence of TBC was 147/100,000 patient-years for all TNF-α inhibitors (249/100,000 and 123/100,000 patient-years for QFT-GIT-positive and negative patients, respectively).

Conclusions: TBC incidence increased by nearly seven times the Turkish national TBC incidence. The QFT-GIT Test appears acceptable to determine latent TBC before biological agent use. Consequently, the QFT-GIT Test can be appropriately used in BCG-vaccinated countries. Key Points • Our study contributes to filling the gap in the literature by reflecting real-life data about TBC frequency after QFT-GIT use in patients receiving biological agents. • The frequency of active TBC will remain within acceptable limits when only QFT-GIT is used in the screening of latent TBC prior to the use of biological agents in a population where the majority are vaccinated with BCG. • Using the QFT-GIT alone for latent TBC screening prior to biologic treatment in countries with high BCG vaccination rates reduces the number of patients needing isoniazid (INH) treatment.
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http://dx.doi.org/10.1007/s10067-020-05443-3DOI Listing
May 2021

Evaluation of inflammatory rheumatic diseases from an emergency medicine perspective.

Int J Rheum Dis 2020 Dec 30;23(12):1670-1675. Epub 2020 Sep 30.

Department of Rheumatology, Yıldırım Beyazıt University School of Medicine, Ankara, Turkey.

Background: Patients with rheumatological complaints may visit an emergency department (ED) because of an acute attack or complication. Because of the recent increased use of immunosuppressant drugs to treat rheumatic diseases, more patients with these conditions visit the ED with a complaint about an infection. However, there are little data on the ED visits of patients with rheumatological complaints. This study evaluated the ED visits of patients with inflammatory rheumatic diseases.

Materials And Methods: A total of 2715 patients (1753 females, 962 males) who had been diagnosed with an inflammatory rheumatic disease and followed up at the rheumatology clinic of Yıldırım Beyazit University, Ankara Atatürk Training and Research Hospital between April 2014 and April 2018 were included in the study. The demographic, clinical, and laboratory characteristics of the patients were obtained from the hospital patient records. The ED visits of these patients were classified into five triage groups (T1: critical, T2: very urgent, T3: urgent, T4: less urgent, T5: not urgent).

Results: Of the 2715 patients, 577 (21.3%) had visited the ED. The three most numerous groups who visited the ED were patients with rheumatoid arthritis (19.8%), ankylosing spondylitis (19.2%), and familial Mediterranean fever (15.9%). Of these 577 patients, 347 (60.1%) were discharged from the ED, 209 (36.2%) were hospitalized in the wards, and 21 (3.6%) were hospitalized in the intensive care unit (ICU). The 3 main reasons for visiting the ED were fever and malaise (n = 152, 26.3%), musculoskeletal complaints (n = 125, 21.7%), and abdominal pain (n = 89, 15.4%). The most numerous group of patients referred by the ED to the wards had vasculitis (n = 38, 17.9%), while the most numerous group of patients referred to the ICU had scleroderma (n = 7, 33.3%). Of the 21 patients who were referred by the ED to the ICU, 16 (76.1%) had respiratory system complaints. Of the 577 patients, 10 (1.7%) died. Eight of the 10 patients (80%) had a rheumatic disease and died after admission to the ICU. The other 2 patients had been diagnosed with pneumonia and myocardial infarction, respectively.

Conclusions: Our study found that visits to the ED by patients with inflammatory rheumatic diseases were classified as urgent or less urgent. Patients with rheumatoid arthritis were the most numerous ED visitors. Vasculitis was the most common cause of hospitalization in the wards and scleroderma was the most common cause of hospitalization in the ICU and death. This suggests that ED physicians should be aware of these patients.
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http://dx.doi.org/10.1111/1756-185X.13982DOI Listing
December 2020

Biological and targeted-synthetic disease-modifying anti-rheumatic drugs with concomitant methotrexate or leflunomide in rheumatoid arthritis: real-life TReasure prospective data.

Clin Exp Rheumatol 2021 Jul-Aug;39(4):852-858. Epub 2020 Sep 4.

Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Division of Rheumatology, Hacettepe University, Ankara, Turkey.

Objectives: To determine the real-life efficacy, safety, and drug-retention rates of leflunomide (LEF) or methotrexate (MTX) as a synthetic DMARD used in combination with biological DMARDs for rheumatoid arthritis (RA).

Methods: The TReasure database is a web-based, prospective, observational cohort of RA and spondyloarthritis patients from 17 centres in different regions of Turkey and data entry was enabled since December 2017. Until May 2019, 2556 RA patients on biologic treatment were recorded. Demographic and RA-related data of 1526 patient either received LEF or MTX were compared, efficacy of both drugs compared by RA-disease activity composite indices. Reasons fordrug discontinuation also recorded. Drug retention rates were compared with Kaplan-Meier curves (log-rank test).

Results: Of 2556 RA patients 1526 (59.7%) were receiving concomitant LEF (n=646, 42.3%; median follow up 35 months) or concomitant MTX (n=880, 57.3%; median follow-up 32 months) at the time of initiation to their first bDMARDs. The LEF group were older and had longer disease duration, proportion of females and seropositive patients was higher in this group. In the LEF group, non-anti-TNF agents were used in higher rate. Remission rates, changes in composite indices and rate of comorbidities and adverse events were similar in both groups. The retention rate of LEF + non-anti-TNF b/tsDMARDs was higher compared to MTX + anti-TNF bDMARDs (p=0.002, log-rank). Rates of adverse events were similar in both groups.

Conclusions: LEF in combination with either anti-TNF or non-anti-TNF drugs appears as an effective and safe therapeutic option at least as MTX.
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July 2021

Evaluation of 17 patients with COVID-19 pneumonia treated with anakinra according to HScore, SOFA, MuLBSTA, and Brescia-COVID respiratory severity scale (BCRSS) scoring systems.

J Med Virol 2021 03 30;93(3):1532-1537. Epub 2020 Dec 30.

Department of Internal Medicine, Division of Rheumatology, Ankara City Hospital, Yıldırım Beyazıt University, Ankara, Turkey.

COVID-19 pandemic has been affecting the whole world by increasing morbidity and mortality rates day by day. Treatment algorithms have been attempted as parallel to the increasing experience with COVID-19. In the pathogenesis of this virus pro-inflammatory cytokine storm has been called to have the main role. The right timing should be made for treatments. We proposed IL- 1 blocking by anakinra in seventeen COVID-19 patients at high risk of worsening. Patients were assessed according to HScore, SOFA (Sequential Organ Failure Assessment Score = SOFA), MuLBSTA Score (multilobular infiltration, hypo-lymphocytosis, bacterial coinfection, smoking history, hyper-tension, and age), Brescia-COVID respiratory severity scale (BCRSS). In our study, the mortality rate was 17.6%. Consequently, 1 (5.9%) patient was receiving low-flow oxygen supply, 3 (17.6%) patients needed no longer oxygen supply and 10 (58.8%) patients were discharged from the hospital. According to the results of our study in the manner of general evaluation; we found that SOFA, MuLBSTA, and BCRSS scores were one step ahead according to HScore being insufficient to determine early phases of the disease. In our opinion, the prominent factors that emphasize the use of anakinra could be listed as comorbidity, risk, or presence of secondary infection, ongoing malignant disease. However, the other factors that enhance the use of anakinra in the situation of viremia also could be sorted as no response to full dose antivirals, antiviral side effects, or no success to antiviral treatment.
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http://dx.doi.org/10.1002/jmv.26473DOI Listing
March 2021

Acute Ischemic Stroke in a Lupus Anticoagulant-Positive Woman With COVID-19.

J Clin Rheumatol 2020 Sep;26(6):236-237

Division of Rheumotology, Department of Internal Medicine, Ankara Yildirim Beyazit University School of Medicine, Ankara, Turkey.

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http://dx.doi.org/10.1097/RHU.0000000000001565DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7437427PMC
September 2020

Disease characteristics of psoriatic arthritis patients may differ according to age at psoriasis onset: cross-sectional data from the Psoriatic Arthritis-International Database.

Clin Exp Rheumatol 2021 May-Jun;39(3):532-536. Epub 2020 Jun 30.

Division of Rheumatology, Department of Internal Medicine, Gazi University, Ankara, Turkey.

Objectives: To explore the impact of early versus late-onset psoriasis (PsO) on the disease characteristics of psoriatic arthritis (PsA) in a large-multicentre cohort.

Methods: The data from a multicentre psoriatic arthritis database was analysed. Patients were grouped according to age at psoriasis onset (early onset; <40 years of age, late-onset; >40 years of age) and disease characteristics of the groups were compared by adjusting for BMI and PsA duration, where necessary.

Results: At the time of analyses, 1634 patients were recruited [62.8% females; early onset 1108 (67.8%); late-onset, 526 (32.2%)]. The late-onset group was more over-weight [66.8% vs. 86.8%, p<0.001; adjusted for age - aOR 1.55 (1.11-2.20; 95% CI)]. The early onset group had more scalp psoriasis at onset (56.7% vs. 43.0%, p<0.001), whereas extremity lesions were more common in the late-onset group (63.8% vs. 74.2%, p<0.001). Axial disease in males and psoriatic disease family history in females were significantly higher in the early onset group [38.0% vs. 25.4%; p=0.005; adjusted for PsA duration - aOR 1.76 (1.19-2.62; 95% CI) / 39.5% vs. 30.1%; p=0.003; OR 1.51 (1.15-1.99; 95% CI), respectively]. Psoriatic disease activity parameters, patient-physician reported outcomes and HAQ-DI scores were similar in both groups.

Conclusions: Clinical features of PsA may be affected by the age at onset of PsO. Different genetic backgrounds in early and late-onset PsO may be driving the differences in psoriasis and PsA phenotypes.
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May 2021

Are type 1 interferons treatment in Multiple Sclerosis as a potential therapy against COVID-19?

Mult Scler Relat Disord 2020 Jul 16;42:102196. Epub 2020 May 16.

Department of Internal Medicine and Division of Rheumatology, Ankara City Hospital, Ankara, Turkey. Electronic address:

Background: The Coronavirus (COVID-19), (Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2)) has been spreading worldwide since its first identification in China. It has been speculated that patients with comorbidities and elderly patients could be at high risk for the pandemic reasoned respiratory insufficiency and death. At first, it was thought that the patients who use immunmodulator therapy could be even at higher risks of disease complications. However, it has been also speculated about that using immunmodulators could be an advantage for the clinical prognosis. Therefore, several immunmodulators are currently being tested as potential treatment for COVID-19.

Methods: In this paper we report on a patient that has been treated with type 1 interferon for multiple sclerosis who developed COVID-19.

Results: Despite using immunmodulator, the symptoms of the patient at hospitalization were mild and he did not show elevated D-dimer, and there was no lymphopenia. He was discharged to home-quarantine with no symptoms.

Discussion: This report supports the idea of using type 1 interferon in the treatment could be effective in COVID-19 affected patients.
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http://dx.doi.org/10.1016/j.msard.2020.102196DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7228888PMC
July 2020

Pregnancy outcomes in partners of male ankylosing spondylitis patients treated with anti-tumour necrosis factor-α biologics: real-life results from a single-centre cross-sectional study.

Rheumatol Int 2020 Sep 28;40(9):1501-1507. Epub 2020 Jan 28.

Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey.

Most patients with inflammatory arthritis are at their reproductive ages. Use of anti-tumour necrosis factor alpha (anti-TNF-α) agents, one of the important treatment options for inflammatory arthritis, can cause foetal morbidity and mortality. While most studies on the effects of anti-TNF-α agents on pregnancy outcomes are about maternal exposure, the number of studies on the risks related to paternal exposure is insufficient. This study aimed to assess pregnancy periods and outcomes of the partners of male ankylosing spondylitis (AS) patients receiving anti-TNF-α treatment during the preconception period. Totally, 163 male AS patients using anti-TNF-α agents were identified from the Hacettepe University Biological Registry. Of these patients, 45 (27.6%) who declared that their partners got pregnant after initiation on anti-TNF-α agents were included. Data regarding demographics and drug exposure and pregnancy and infant outcomes were evaluated. Of 45 pregnancies, 39 (86.7%) resulted in healthy live births, 3 (6.7%) resulted in spontaneous abortion, and 3 (6.7%) were terminated with curettage. Of 39 live births, 34 (87.2%) were term and 5 (12.8%) were preterm, 30 (76.9%) had normal birth weight, 6 (15.4%) had low birth weight, and 3 (7.7%) had fetal macrosomia. No congenital malformations related to paternal exposure were observed. This study is valuable as being one of the studies providing pregnancy outcomes of partners of male AS patients receiving anti-TNF-α agents with its relatively high number of patients. The results suggested that paternal exposure to anti-TNF-α agents during preconception period could be safe on pregnancy outcomes.
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http://dx.doi.org/10.1007/s00296-020-04518-3DOI Listing
September 2020

Psoriasis Symptom Inventory (PSI) as a patient-reported outcome in mild psoriasis: Real life data from a large psoriatic arthritis registry.

Eur J Rheumatol 2020 Apr 6;7(2):64-67. Epub 2020 Jan 6.

Division of Rheumatology, Department of Internal Medicine, Hacettepe University, Ankara, Turkey.

Objective: Our aim is to test the validity of the Psoriasis Symptom Inventory (PSI), a patient-reported outcome, to assess the psoriasis severity within the scope of rheumatology.

Methods: Within the PsA international database (PSART-ID), 571 patients had PSI, while 322 of these also showed body surface area (BSA). Correlations between PSI, BSA, and other patient- and physician-reported outcomes were investigated.

Results: There was a good correlation between PSI and BSA (r=0.546, p<0.001), which was even higher for mild psoriasis (BSA<3 (n=164): r=0.608, p<0.001). PSI significantly correlated with fatigue, pain, and patient and physician global parameters (p<0.001).

Conclusion: PSI has a good correlation with other patient- and physician-reported outcomes, and our findings support its use in rheumatology practice.
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http://dx.doi.org/10.5152/eurjrheum.2019.19126DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7343223PMC
April 2020

Geoepidemiology and clinical characteristics of neonatal lupus erythematosus: a systematic literature review of individual patients’ data

Turk J Med Sci 2020 01 9;50(1):281-290. Epub 2020 Jan 9.

Division of Rheumatology, Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey

Background/aim: Neonatal lupus erythematosus (NLE) is an autoimmune syndrome caused by transplacental transmission of maternal autoantibodies, often with devastating consequences. The objective of this systematic literature review was to analyze the demographic data, geoepidemiology, clinical, and serological characteristics associated with NLE.

Materials And Methods: We performed a systematic literature search of the Pubmed database covering the period from 1976 to August 2015, using the MeSH terms “neonatal lupus” or “congenital heart block”. To be included in the study, articles of any type (original articles, case series, and case reports) had to report on infants with NLE on an individualized (i.e. patient-by-patient) basis.

Results: A total of198 studies were included in the review, reporting on a total of 755 NLE patients. The most frequently reported clinical manifestations of NLE were congenital heart block (CHB, 65.2%), cutaneous lupus (33.1%), and cytopenias (15.5%). We found differences in NLE characteristics based on study geographical origin, with CHB being much more frequent in patients of European or American descent (49.4% and 35%, respectively), while reports originating from Asia reported a higher prevalence of skin involvement (45.2%). Most CHB cases (72.9%) were diagnosed between the 18th and 26th week of gestation.

Conclusions: Phenotypic differences of NLE depending on race and country may reflect true pathophysiologic differences or methodologic discrepancies. While maternal autoimmune disease is not a prerequisite for the development of NLE, the existence of a truly “immunonegative” CHB is questionable.
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http://dx.doi.org/10.3906/sag-1910-39DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7164747PMC
January 2020

Current Smoking Is Increased in Axial Psoriatic Arthritis and Radiographic Sacroiliitis.

J Rheumatol 2019 Dec 1. Epub 2019 Dec 1.

From the University of Ottawa Faculty of Medicine, Rheumatology, and Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Hacettepe University, Faculty of Medicine, Department of Internal Medicine, Division of Rheumatology, Hacettepe University Hospital, Ankara, Turkey; Unit of Rheumatology, Sacro Cuore-Don Calabria Hospital, Negrar, Verona, Italy; Ege University, Department of Internal Medicine, Division of Rheumatology, Izmir, Turkey; Suleyman Demirel University, Department of Internal Medicine, Division of Rheumatology, Isparta, Turkey; Uludag University, Department of Internal Medicine, Division of Rheumatology, Bursa, Turkey; Mustafa Kemal University, Department of Internal Medicine, Division of Rheumatology, Hatay, Turkey; Diskapi Yildirim Beyazit Education and Research Hospital, Department of Internal Medicine, Division of Rheumatology, Ankara, Turkey; Kahramanmaras Sutcu Imam University, Department of Internal Medicine, Division of Rheumatology, Kahramanmaras, Turkey; Ankara Numune Education and Research Hospital, Department of Internal Medicine, Division of Rheumatology, Ankara, Turkey; Marmara University, Department of Internal Medicine, Division of Rheumatology, Istanbul, Turkey; Selcuk University, Department of Internal Medicine, Division of Rheumatology, Konya, Turkey. D. Solmaz had funding from Union ChimiqueBelge (UCB) for an axial spondyloarthritis fellowship. S. Bakirci had funding from the Turkish Society for Rheumatology (TRD). S.Z. Aydin received honoraria from Abbvie, Celgene, UCB, Novartis, Jannsen, and Sanofi. D. Solmaz, MD, University of Ottawa Faculty of Medicine, Rheumatology; U. Kalyoncu, MD, Associate Professor, Hacettepe University, Faculty of Medicine, Department of Internal Medicine, Division of Rheumatology; I. Tinazzi, MD, Unit of Rheumatology, Sacro Cuore-Don Calabria Hospital; S. Bakirci, MD, University of Ottawa Faculty of Medicine, Rheumatology; O. Bayindir, MD, Ege University, Department of Internal Medicine, Division of Rheumatology; A. Dogru, MD, Suleyman Demirel University, Department of Internal Medicine, Division of Rheumatology; E. Dalkilic, MD, Associate Professor, Uludag University, Department of Internal Medicine, Division of Rheumatology; G. Kimyon, MD, Mustafa Kemal University, Department of Internal Medicine, Division of Rheumatology; C. Ozisler, MD, Diskapi Yildirim Beyazit Education and Research Hospital, Department of Internal Medicine, Division of Rheumatology; G.Y. Cetin, MD, Associate Professor, Kahramanmaras Sutcu Imam University, Department of Internal Medicine, Division of Rheumatology; L. Kilic, MD, Hacettepe University, Department of Internal Medicine, Division of Rheumatology, Hacettepe University Hospital; A. Omma, MD, Ankara Numune Education and Research Hospital, Department of Internal Medicine, Division of Rheumatology; M. Can, MD, Associate Professor, Marmara University, Department of Internal Medicine, Division of Rheumatology; S. Yilmaz, MD, Professor, Selcuk University, Department of Internal Medicine, Division of Rheumatology; A. Erden, MD, Hacettepe University, Department of Internal Medicine, Division of Rheumatology; S.Z. Aydin, MD, Associate Professor, University of Ottawa Faculty of Medicine, Ottawa Hospital Research Institute. Address correspondence to Dr. S.Z. Aydin, 1967 Riverside Drive, Ottawa, Ontario K1H 7W9, Canada. E-mail: Accepted for publication November 13, 2019.

Objective: The effect of smoking in psoriatic arthritis (PsA) is under debate. Our aim was to test whether smoking is increased in axial PsA (axPsA).

Methods: Included in the analysis were 1535 patients from PsArt-ID (PsA-International Database). The effect of smoking on axPsA (compared to other PsA phenotypes) and radiographic sacroiliitis were investigated.

Results: Current smoking was more common in axPsA (28.6% vs 18.9%, p < 0.001). It also was found as an independent predictor of axPsA (OR 1.4) and radiographic sacroiliitis (OR 6.6).

Conclusion: Current smoking is significantly associated with both axPsA and radiographic sacroiliitis in patients with PsA.
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http://dx.doi.org/10.3899/jrheum.190722DOI Listing
December 2019
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