Browsing by Author "Ayhan, F"
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Item THE RELATIONSHIP BETWEEN MRI FINDINGS, PAIN AND DISABILITY IN THE PATIENTS WITH CERVICAL OSTEOARTHRITISAltan, L; Ökmen, BM; Tuncer, T; Akarirmak, U; Ayhan, F; Bal, A; Bozbas, G; Cerrahoglu, L; Cevik, R; Durmaz, B; Duruöz, T; Dülgeroglu, D; Gürer, G; Gürsoy, S; Hepgüler, S; Hizmetli, S; Kaçar, C; Kaptanoglu, E; Kocabas, H; Nas, K; Nur, H; Özçakir, S; Özdolap, S; Sindel, D; Sahin, O; Sendur, F; Tikiz, C; Ugurlu, HItem Management of Rheumatoid Arthritis: Consensus Recommendations From the Turkish League Against RheumatismAtaman, S; Borman, P; Evcik, D; Aydog, E; Ayhan, F; Yildizlar, D; Bodur, H; Altay, Z; Birtane, M; Bütün, B; Duruöz, T; Erdem, HR; Gunendi, Z; Günaydin, R; Gürer, G; Kaçar, C; Kaptanoglu, E; Kaya, T; Ölmez, N; Paker, N; Rezvani, A; Tur, BS; Yener, M; Özgöçmen, SObjectives: Taking new developments in the management of rheumatoid arthritis (RA) and the economic conditions of our country into account, the Turkish League Against Rheumatism (TLAR) aimed to develop national treatment recommendations for the management of RA; thus, they consulted with national experts for their opinions. Materials and methods: Eight rheumatologists and 15 physiatrists experienced in the field contributed to the development of the TLAR recommendations for the management of RA. The expert committee planned to develope Recommendations for the Management of RA in Turkey based on EULAR 2010 recommendations for the management of RA with synthetic and biological disease-modifying antirheumatic drugs (DMARDs) in light of expert opinions. Following the meeting, a systematic literature review was performed by searching the Medline and Cochrane, Embase, and Turkish Medical Index databases between 2009 and 2010 for pharmacological treatment recommendations and between 2007 and 2010 for non-pharmacological treatment recommendations. This was done in addition to the studies included in the EULAR 2010 recommendations. All articles were examined, their contents were summarized, their levels of evidence were determined, and the Delphi process was initiated. Results: Sixteen general recommendations were listed along with five main principles and one non-pharmacological treatment method. A consensus was reached for all recommendations, and their strength levels were voted upon. Conclusion: Recommendations were formed for the management of RA in Turkey. These national recommendations are intended to guide physical medicine and rehabilitation specialists (physiatrists), rheumatologists, and family physicians and should be regularly updated.Item THE FREQUENCY AND ASSOCIATION OF KNEE, HIP, HAND AND SPINE OSTEOARTHRITIS IN TURKISH POPULATION: A PRELIMINARY RE PORT OF MULTICENTER LONGITUDINAL STUDYTuncer, T; Ugur, S; Nur, H; Kacar, C; Akarimak, U; Altan, L; Ayhan, F; Bal, A; Basaran, S; Bilgilisoy, M; Bozbas, G; Cerrahoglu, L; Cevik, R; Coskun, N; Dagli, Z; Durmaz, B; Duruoz, T; Dulgeroglu, D; Gurer, G; Gursoy, S; Hepguler, S; Hizmetli, S; Kaplanoglu, E; Kaya, T; Kocabas, H; Kuran, B; Melikoglu, M; Nas, K; Oncu, J; Ozcakir, S; Ozdolap, S; Saridogan, M; Sarikaya, S; Sindel, D; Sahin, O; Sendur, OF; Tikiz, C; Ugurlu, H; Yilmaz, FItem 2017 update of the Turkish League Against Rheumatism (TLAR) evidence-based recommendations for the management of knee osteoarthritisTuncer, T; Cay, FH; Altan, L; Gurer, G; Kacar, C; Ozcakir, S; Atik, S; Ayhan, F; Durmaz, B; Eskiyurt, N; Genc, H; GokceKutsal, Y; Gunaydin, R; Hepguler, S; Hizmetli, S; Kaya, T; Kurtais, Y; Saridogan, M; Sindel, D; Sutbeyaz, S; Sendur, OF; Ugurlu, H; Unlu, ZIn a Turkish League Against Rheumatism (TLAR) project, evidence-based recommendations for the management of knee osteoarthritis (OA) was developed for the first time in our country in 2012 (TLAR-2012). In accordance with developing medical knowledge and scientific evidence, recommendations were updated. The committee was composed of 22 physical medicine and rehabilitation specialists (4 have rheumatology subspeciality also) and an orthopaedic surgeon. Systematic literature search were applied on Pubmed, Embase, Cochrane and Turkish Medical Index for the dates between January the 1st 2012 and January the 29th of 2015. The articles were assessed for quality and classified according to hierarchy for the level of evidence, and the selected ones sent to committee members electronically. They were asked to develop new recommendations. In the meeting in 2015, the format of the recommendations was decided to be patient-based and considering the grade and the severity of the disease. By the discussion of the each item under the light of new evidences, the final recommendations were developed. Each item was voted electronically on a 10-cm visual analogue scale (VAS) and the strength of recommendation (SoR) was calculated. In the light of evidences, totally 11 titles of recommendations were developed; the first 7 were applicable to each patient in every stages of the disease, remaining were for defined specific clinical situations. The mean SoR value of the recommendations was between 7.44 and 9.93. TLAR-2012 recommendations were updated in a new format. We think that, present recommendations will be beneficial for the physicians who manage, as well as the patients who suffer from the disease.Item THE RADIOLOGICAL, CLINICAL AND FUNCTIONAL PROPERTIES OF HAND OSTEOARTHRITIS AND THEIR RELATION WITH RADIOLOGICAL FINDINGS IN A TURKISH POPULATION: TLAR-OA STUDYDuruöz, MT; Erdem, D; Tuncer, T; Altan, L; Ayhan, F; Bal, A; Cerrahoglu, L; Capkin, E; Cevik, R; Dulgeroglu, D; Gursoy, S; Hizmetli, S; Kacar, C; Kaptanoglu, E; Kaya, T; Kocabas, H; Nas, K; Ozcakir, S; Sindel, D; Sahin, O; Bozbas, GT; Tikiz, C; Ugurlu, HItem LIMPRINT Study: The Turkish ExperienceBorman, P; Moffatt, C; Murray, S; Yaman, A; Denizli, M; Dalyan, M; Unsal-Delialioglu, S; Eyigör, S; Ayhan, F; Çakit, BD; Vural, S; Özdemir, O; Kurt, E; Çelik, EC; Cerrahoglu, L; Kepekçi, M; Terzioglu, F; Donmez, AABackground: Lymphedema and chronic edema is a major health care problem in both developed and nondeveloped countries The Lymphoedema Impact and Prevelance - International (LIMPRINT) study is an international health service-based study to determine the prevalence and functional impact in adult populations of member countries of the International Lymphoedema Framework (ILF). Methods and Results: A total of 1051 patients from eight centers in Turkey were recruited using the LIMPRINT study protocol. Data were collected using the core and module tools that assess the demographic and clinical properties as well as disability and quality of life (QoL). Most of the Turkish patients were recruited from specialist lymphedema services and were found to be women, housewives, and having secondary lymphedema because of cancer treatment. The duration of lymphedema was commonly <5 years and most of them had International Society of Lymphology (ISL) grade 2 lymphedema. Cellulitis, infection, and wounds were uncommon. The majority of patients did not get any treatment or advice before. Most of the patients had impaired QoL and decreased functionality, but psychological support was neglected. Although most had social health security access to lymphedema centers, nevertheless access seemed difficult because of distance and cost. Conclusion: The study has shown the current status and characteristics of lymphedema patients, treatment conditions, the unmet need for the diagnosis and treatment, as well as burden of the disease in both patients and families in Turkey. National health policies are needed for the prevention, diagnosis, and treatment in Turkey that utilize this informative data.Item The clinical and demographical characteristics of Turkish pediatric lymphedema patients: a multicenter studyBorman, P; Balcan, A; Eyigör, S; Coskun, E; Ayhan, F; Çakit, BD; Vural, S; Vural, M; Çakir, EDP; Çagdas, D; Yaman, A; Cerrahoglu, L; Dogan, SCBackground/aim: Reducing lymphedema-associated burden and disability in the pediatric setting requires improved awareness and understanding clinical properties of the lymphedema. The aim of this study was to evaluate the clinical and demographic characteristics of patients with pediatric lymphedema presented to different lymphedema centers in Turkey. Materials and methods: The socio-demographic and clinical characteristics of the children including age, gender, presence of genetic syndromes, duration of edema, site and stage of lymphedema and the received therapies were determined. Parental and children education on self-management techniques were recorded. Results: A total of 122 children (female: 66, male: 56) with a mean age of 120.7 +/- 71.2 months were included from 7 centers. Of them; 92% had primary, 8% had secondary lymphedema mostly due to infection and trauma. Lymphedema was part of a syndrome in 18% of the children. The most common site of involvement was the lower extremity, followed by upper extremity and genital involvement. Lymphedema was complicated in 17 % of children, mainly with a clinical picture of cellulitis, infection, and pain. The median duration of lymphedema was 41 (5-216) months. Although most of the children had stage 2 lymphedema, only 40% of them received treatment. The most commonly received treatment was compression therapy. No family or child was educated for self-care management before. Conclusion: In conclusion, pediatric lymphedema has a comparable gender distribution and usually involves the lower extremities. Although most of the children had advanced disease, more than half of the patients did not receive any treatment indicating the unmet need for management of lymphedema. The education of patients and/or children about self-management methods were lacking. We suggest educational activities for both families of children with lymphedema and health care providers, in order to facilitate early reference to lymphedema units and to receive prompt preventive and therapeutic approaches for this suffering condition.Item Correlation of clinical signs and magnetic resonance imaging findings in patients with lumbar spondylosisAltan, L; Ökmen, BM; Tuncer, T; Sindel, D; Çay, HF; Hepgüler, S; Sarikaya, S; Ayhan, F; Bal, A; Bilgilisoy, M; Çapkin, E; Cerrahoglu, L; Çevik, R; Dülgeroglu, D; Durmaz, B; Duruöz, T; Gürer, G; Gürsoy, S; Hizmetli, S; Kaçar, C; Kaptanoglu, E; Ecesoy, H; Melikoglu, M; Nas, K; Nur, H; Özcakir, S; Sahin, N; Sahin, O; Saridogan, M; Sendur, ÖF; Sezer, I; Bozbas, GT; Tikiz, C; Ugurlu, HObjectives: The purpose of the study was to contribute further to this debated topic by investigating the correlation of magnetic resonance imaging (MRI) findings with the clinical picture in lumbar spondylosis patients.Patients and methods: This multicenter retrospective study (as part of the epidemiological project of the TLAR-OASG [Turkish League Against Rheumatism-Osteoarthritis Study Group]) included 514 patients (101 males, 413 females; mean age: 63.6 +/- 10.8 years; range, 40 to 85 years) who were diagnosed as lumbar spondylosis by clinical examination and direct X-ray between December 2016 and June 2018. Demographic characteristics of patients, Visual Analog Scale for pain, presence of radiating pain, Roland-Morris disability questionnaire, straight leg raise test, deep tendon reflexes, neurogenic intermittent claudication symptoms, any decrease of muscle strength, and abnormality of sensation were recorded. Lumbar MRI findings of the patients were recorded as positive or negative in terms of disc herniation, intervertebral disc degeneration, root compression, osteophytes, spinal stenosis. Statistical analysis was done to assess the correlation between the clinical symptoms, physical examination, and MRI findings.Results: Correlation analysis of the MRI results and the clinical findings showed a significant correlation between straight leg raise test and root compression (p<0.001, r=0.328) and a significant correlation between neurogenic intermittent claudication and spinal stenosis (p<0.001, r=0.376). Roland-Morris disability questionnaire had a significant correlation with all MRI findings (p<0.05, r<0.200). Conclusion: The results of this study corroborate the notion that diligent patient history and physical examination are more valuable than MRI findings, even though a higher incidence of abnormal MRI findings have been obtained in patients with disability and dermatomal radiating pain.Item Management of Psoriatic Arthritis: Turkish League Against Rheumatism (TLAR) Expert OpinionsNas, K; Kiliç, E; Çevik, R; Bodur, H; Ataman, S; Ayhan, F; Akgül, Ö; Akinci, A; Altay, Z; Çapkin, E; Dagli, AZ; Duruöz, T; Gürer, G; Gögüs, F; Garip, Y; Kaçar, C; Kamanli, A; Kaptanoglu, E; Kaya, T; Kocabas, H; Özdemirel, EA; Özel, S; Sezer, I; Sunar, I; Yilmaz, GObjectives: 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.Item Neuropathic Pain in Patients with Knee Osteoarthritis and Related Factors: A Multicenter Longitudinal Study-Preliminary ReportKaptanoglu, E; Sahin, O; Tuncer, T; Hizmetli, S; Altan, L; Ayhan, F; Bal, A; Bilgilisoy, M; Bozbas, G; Cerrahoglu, L; Cevik, R; Duruoz, T; Dulgeroglu, D; Gurer, G; Gursoy, S; Hepguler, S; Kacar, C; Kaya, T; Melikoglu, M; Nas, K; Ozcakir, S; Ozdolap, S; Saridogan, M; Sarikaya, S; Sindel, D; Sendur, OF; Tikiz, C; Ugurlu, HItem The clinical, functional, and radiological features of hand osteoarthritis: TLAR-osteoarthritis multi-center cohort studyDuruöz, MT; Gürsoy, DE; Tuncer, T; Altan, L; Ayhan, F; Bal, A; Bilgilisoy, M; Cerrahoglu, L; Çapkin, E; Çay, HF; Çevik, R; Durmaz, B; Dülgeroglu, D; Gürer, G; Gürsoy, S; Hepgüler, S; Hizmetli, S; Kaçar, C; Kaptanoglu, E; Kaya, T; Ecesoy, H; Melikoglu, MA; Nas, K; Nur, H; Özçakir, S; Saridogan, M; Sarikaya, S; Sezer, I; Sindel, D; Sahin, N; Sahin, Ö; Sendur, ÖF; Bozbas, GT; Tikiz, C; Ugurlu, HObjectives: This study aims to evaluate the clinical, functional, and radiological features of hand osteoarthritis (OA) and to examine their relationships in different geographic samples of the Turkish population. Patients and methods: Between April 2017 and January 2019, a total of 520 patients (49 males, 471 females; mean age: 63.6 +/- 9.8 years) with hand OA were included in the study from 26 centers across Turkiye by the Turkish League Against Rheumatism (TLAR). The demographic characteristics, grip strengths with Jamar dynamometer, duration of hand pain (month), the severity of hand pain (Visual Analog Scale [ VAS]), and morning stiffness were evaluated. The functional disability was evaluated with Duruoz Hand Index (DHI). The Kellgren-Lawrence (KL) OA scoring system was used to assess the radiological stage of hand OA. Results: The DHI had significant correlations with VAS- pain (r= 0.367, p<0.001), duration of pain (r=0.143, p=0.001) and bilateral handgrip strengths (r=-0.228, p=0.001; r=-0.303, p<0.001). Although DHI scores were similar between the groups in terms of the presence of hand deformity (p= 0.125) or Heberden's nodes (p=0.640), the mean DHI scores were significantly higher in patients with Bouchard's nodes (p=0.015). The total number of nodes had no significant correlations with the VAS-pain and DHI score (p>0.05). The differences between the groups of radiological hand OA grades in terms of age (p= 0.007), VAS-pain (p<0.001), duration of pain (p<0.001), and DHI (p<0.001) were significant. There were no significant differences between radiological hand OA grades according to the duration of the stiffness, grip strength, and BMI (p>0.05 for all). Conclusion: In our population, the patients with hand OA had pain, functional disability, and weak grip strength. The functional impairment was significantly correlated with the severity of the pain, and the functional status was worse in high radiological hand OA grades.Item Description of the registry of patients with ankylosing spondylitis in Turkey: TRASD-IPBodur, H; Ataman, S; Bugdayci, DS; Rezvani, A; Nas, K; Uzunca, K; Emlakcioglu, E; Karatepe, AG; Durmuus, B; Sezgin, M; Ayhan, F; Yazgan, P; Duruöoz, T; Yener, M; Gürgan, A; Kirnap, M; Çakar, E; Altan, L; Soydemir, R; Çapkin, E; Tekeoglu, I; Aydin, G; Günendi, Z; Nacir, B; Salli, A; Öztürk, C; Memis, A; Turan, Y; Kozanoglu, E; Sivrioglu, KA web-based application patient follow-up program was developed to create a registry of patients with ankylosing spondylitis (AS) by the Turkiye Romatizma Arastirma Savas Dernegi (TRASD) AS Study Group. This study describes the methodological background and patient characteristics. The patient follow-up program is a web-based questionnaire, which contains sections on socio-demographic data, anamnesis, personal and family history, systemic and musculoskeletal examination, laboratory and imaging data and treatment. Between October 1, 2007 and February 28, 2009, 1,381 patients from 41 centers were included in the registry (1,038 males [75.2%]; mean age 39.5 +/- A 10.7 years). Mean disease duration was 12.1 +/- A 8.5 years, and mean time from initial symptom to diagnosis was 5 +/- A 6.8 years (median 2 years). HLA-B27 positivity was detected in 73.7% of 262 patients tested. Manifestations of extraarticular involvement were anterior uveitis (13.2%), psoriasis and other skin and mucous membrane lesions (6%) and inflammatory bowel disease (3.8%). The prevalence of peripheral arthritis was 11.2%. In 51.7% of patients, the Bath AS Disease Activity Index was a parts per thousand yen4. But since our patients consisted of the ones with more severe disease who referred to the tertiary centers and needed a regular follow-up, they may not represent the general AS population. Disease-modifying anti-rheumatic drugs were being used by 41.9% of patients, with 16.4% using anti-TNF agents. TRASD-IP (Izlem Programi: Follow-up program) is the first AS registry in Turkey. Such databases are very useful and provide a basis for data collection from large numbers of subjects. TRASD-IP gives information on the clinical and demographic profiles of patients, and the efficacy and safety of anti-TNF drugs, examines the impact on quality of life, and provides real-life data that may be used in cost-effectiveness analyses.Item Correlations among enthesitis, clinical, radiographic and quality of life parameters in patients with ankylosing spondylitisRezvani, A; Bodur, H; Ataman, S; Kaya, T; Bugdayci, DS; Demir, SE; Koçyigit, H; Altan, L; Ugurlu, H; Kirnap, M; Gür, A; Kozanoglu, E; Akinci, A; Tekeoglu, I; Sahin, G; Bal, A; Sivrioglu, K; Yazgan, P; Aydin, G; Hepgüler, S; Ölmez, N; Sendur, ÖF; Yener, M; Altay, Z; Ayhan, F; Durmus, O; Duruöz, MT; Günendi, Z; Nacir, B; Öken, Ö; Toktas, H; Delialioglu, SÜ; Evcik, D; Sertpoyraz, FMObjectives. To investigate the relationship between enthesitis and disease activity, functional status, fatigue, joint mobility, radiological damage, laboratory parameter and quality of life in patients with ankylosing spondylitis (AS). Methods. A total of 421 patients with AS (323 male and 98 female) who were included in the Turkish League Against Rheumatism Registry were enrolled in the study. The Bath AS Disease Activity Index (BASDAI), fatigue, the Bath AS Functional Index (BASFI), the Bath AS Metrology Index (BASMI), the Maastricht AS Enthesitis Score (MASES), AS quality of life (ASQoL), the Bath AS Radiology Index (BASRI) and erythrocyte sedimentation rate (ESR) were evaluated. Results. Enthesitis was detected in 27.3% of patients. There were positive correlations between MASES and BASDAI, BASFI and fatigue (p < 0.05). MASES was not correlated with BASRI, BASMI, ASQoL and ESR. The mean MASES score was 1.1 +/- 2.4. The most frequent regions of enthesopathies were right iliac crest, spinous process of L5 and proximal to the insertion of left achilles tendon, respectively. Conclusions. Enthesitis was found to be associated with higher disease activity, higher fatigue, worse functional status and lower disease duration. As enthesitis was correlated with BASDAI, we conclude that enthesitis can reflect the disease activity in patients with AS.Item 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 TLARAtaman, S; Sürmeli, ZS; Sunar, I; Özdemirel, E; Akinci, A; Bodur, H; Akgül, Ö; Altan, L; Altay, Z; Ayhan, F; Birtane, M; Soy Bugdayci, D; Çapkin, E; Cerrahoglu, L; Duruöz, MT; Günaydin, R; Günendi, Z; Gürer, G; Bal, A; Kaçar, C; Kaptanoglu, E; Kaya, T; Kocabas, H; Kotevoglu, N; Nas, K; Rezvani, A; Sen, N; Sendur, OF; Yalçin, PObjectives: This study aims to report Turkish League Against Rheumatism's 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. Materials 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.