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    A Gender-based Analysis of Disease Activity and Its Relationship with Anxiety, Depression, Fatigue, and Fibromyalgia in Psoriatic Arthritis
    (Wiley, 2019) Duruoz, Mehmet Tuncay; Gezer, Halise Hande; Nas, Kemal; Kilic, Erkan; Sargin, Betul; Kasman, Sevtap Acer; Tuncer, Tiraje
    Background/Purpose: This study sought to compare the disease activity and its relationship with anxiety, depression, fatigue, and fibromyalgia of patients with psoriatic arthritis (PsA) between female and male gender in a Turkish population. Methods: This multi-center Turkish League Against Rheumatism (TLAR) Network study included 1134 patients (726 females, 408 males) diagnosed with PsA according to the CASPAR criteria. Demographic and clinic parameters of the patients were recorded. Disease activity was evaluated using the scores of DAS28, DAPSA, cDAPSA, MDA, VLDA, and BASDAI. Health Assessment Questionnaire (HAQ), SF-36, Hospital Anxiety and Depression Scale (HAD), fatigue VAS (0-10), and Fibromyalgia Rapid Screening Tool (FIRST) were assessed. Disease activity and remission rates were compared in male and female patients, and their relationship with fatigue, anxiety, depression, and fibromyalgia scores was analyzed. The Spearman correlation coefficient was used to assess correlations. Comparisons were made using the Mann-Whitney U and chi-squared tests. p< 0.05 was considered significant. Results: The mean age of the patients was 47.4 years (SD:12.1) for females, 46 years (SD:12.2) for males (Table-1). Disease activity scores of DAS28, DAPSA, cDAPSA, and BASDAI were significantly higher in women than in men (p< 0.05) (Table-2), with men having both higher remission and low-activity rates. There was a significant difference in the rate of MDA in favor of men (p< 0.05), but not in the rate of VLDA. The frequencies of dactylitis, enthesitis, inflammatory bowel disease, and arthritis were similar in men and women, while men had a higher incidence of spondylitis (p< 0.05). Both men and women with MDA had significant improvements in the scores of fatigue, HAQ, FIRST, anxiety and depression as well as in SF-36 subscales as compared with their counterparts without MDA (p< 0.05). Overall, although there was no significant between-group difference in age, body mass index, and disease duration, women had significantly higher anxiety, depression, and FIRST scores (fibromyalgia) compared with men (p< 0.05) (Table-2). In both men and women, disease activity scores of DAPSA, DAS28, and BASDAI were significantly correlated with the scores of FIRST, anxiety, depression, fatigue, and HAQ (p< 0.05). Conclusion: In patients with PsA, women seem to have lower levels of remission and higher levels of disease activity than men. In both women and men, disease activity scores are significantly correlated with fatigue, functional status, anxiety, depression, fibromyalgia, and quality of life.
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    Öğe
    Gender-related differences in disease activity and clinical features in patients with peripheral psoriatic arthritis: A multi-center study
    (Elsevier France-Editions Scientifiques Medicales Elsevier, 2021) Duruoz, Mehmet Tuncay; Gezer, Halise Hande; Nas, Kemal; Kilic, Erkan; Sargin, Betul; Kasman, Sevtap Acer; Alkan, Hakan
    Objective: This study sought to compare disease activity, clinical features, and patient-reported outcomes concerning anxiety, depression, fatigue, function, quality of life, and fibromyalgia between female and male patients with peripheral PsA in a Turkish population. Methods: This multi-center Turkish League Against Rheumatism (TLAR) Network study included 1038 patients (678 females, 360 males) diagnosed with peripheral PsA according to the CASPAR criteria. The demographic and clinic parameters of the patients were recorded. Disease activity was evaluated using the scores of DAS28 and cDAPSA. Remission, minimal disease activity (MDA), and very low disease activity (VLDA) were determined. Health Assessment Questionnaire (HAQ), Short-Form-36 (SF-36), Hospital Anxiety and Depression Scale (HAD), fatigue VAS (0-10), and Fibromyalgia Rapid ScreeningTool (FiRST) were used. Disease activity and patient-reported outcomes were compared in male and female patients, and the predictors of MDA for both genders were analyzed. Results: The patients' mean age was 47.6 years (SD: 12) for females and 46.3 years (SD: 12.3) for males. In terms of DAS28 and cDAPSA, female patients had significantly higher disease activity scores, while male patients had significantly higher remission rates (P<0.05). There was a significant difference in the rate of MDA in favor of males (P<0.05), but not in VLDA. The incidences of dactylitis, enthesitis, tenosynovitis, and inflammatory bowel disease were similar in male and female patients, except for spondylitis, which was higher in males (P<0.05). Overall, although there was no significant between-group difference in age and disease duration, female patients had significantly higher BMI and late-onset disease (P<0.05). Female patients had higher HAD, HAQ, and FiRST and lower SF-36 scores than males (P<0.05). In both male and female patients, the disease activity score of cDAPSA was significantly correlated with the scores of FiRST, HAD, VAS-F, and HAQ(P< 0.05). In regression analysis, tender joint count, swollen joint count, PASI, pain VAS, and enthesitis were the MDA predictors in both genders. Conclusion: In patients with peripheral PsA, males are more likely to develop spondylitis while other extraarticular manifestations are similar. Female patients appear to have lower rates of remission and MDA and higher levels of disease activity. Female patients experience a more severe course of PsA, with higher levels of pain and fatigue, lower quality of life, and increased functional limitations. The predictors of MDA, i.e., tender joint count, swollen joint count, PASI, pain VAS, and enthesitis are similar between the two genders. (C) 2021 Societe francaise de rhumatologie. Published by Elsevier Masson SAS. All rights reserved.
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    The impact of fatigue on patients with psoriatic arthritis: a multi-center study of the TLAR-network
    (SPRINGER HEIDELBERG, 2020) Duruoz, Mehmet Tuncay; Gezer, Halise Hande; Nas, Kemal; Kilic, Erkan; Sargin, Betul; Acer Kasman, Sevtap; Alkan, Hakan
    Fatigue is a substantial problem in patients with psoriatic arthritis (PsA) that needs to be considered in the core set of domains. This study aimed to evaluate fatigue and its relationship with disease parameters, functional disability, anxiety, depression, quality of life, and correlation with disease activity as determined by various scales. A total of 1028 patients (677 females, 351 males) with PsA who met the CASPAR criteria were included [Turkish League Against Rheumatism (TLAR) Network multicenter study]. The demographic features and clinical conditions of the patients were recorded. Correlations between fatigue score and clinical parameters were evaluated using the Disease Activity Score 28 (DAS28), Disease Activity in Psoriatic Arthritis (DAPSA), Clinical DAPSA (cDAPSA), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), the Fibromyalgia Rapid Screening Tool (FiRST), minimal disease activity (MDA), and very low disease activity (VLDA). Fatigue was assessed with the Functional Assessment of Chronic Illness Therapy (FACIT-F) and a 10-point VAS (VAS-F). The mean age of the patients was 47 (SD: 12.2) years, and the mean disease duration was 6.4 (SD: 7.3) years. The mean VAS-F score was 5.1 (SD: 2.7), with fatigue being absent or mild, moderate, and severe in 12.8%, 24.6%, and 62.5% of the patients, respectively. Fatigue scores were significantly better in patients with DAS28 remission, DAPSA remission, cDAPSA remission, MDA, and VLDA (p < 0.001). Fatigue scores significantly increased with increasing disease activity levels on the DAS28, DAPSA, and cDAPSA (p < 0.001). VAS-F scores showed correlations with the scores of the BASDAI, BASFI, PsAQoL, HAD-A, FiRST, pain VAS, and PtGA. FiRST scores showed fibromyalgia in 255 (24.8%) patients. FACIT-F and VAS-F scores were significantly higher in patients with fibromyalgia (p < 0.001). In regression analysis, VLDA, BASDAI score, FiRST score, high education level, HAD-Anxiety, and BMI showed independent associations with fatigue. Our findings showed that fatigue was a common symptom in PsA and disease activity was the most substantial predictor, with fatigue being less in patients in remission, MDA, and VLDA. Other correlates of fatigue were female gender, educational level, anxiety, quality of life, function, pain, and fibromyalgia.
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    Öğe
    Inconsistencies of the Disease Activity Assessment Tools for Psoriatic Arthritis: Challenges to Rheumatologists
    (Elsevier France-Editions Scientifiques Medicales Elsevier, 2022) Gezer, Halise Hande; Duruoz, Mehmet Tuncay; Nas, Kemal; Kilic, Erkan; Sargin, Betul; Kasman, Sevtap Acer; Alkan, Hakan
    Objective: Currently, concerning the evaluation of psoriatic arthritis (PsA), there is no agreement on a standardized composite index for disease activity that includes all relevant domains. The present study sought to assess the rates of remission (REM)/low disease activity (LDA) and disease states [minimal disease activity (MDA), very low disease activity (VLDA)] as defined by diverse activity scales (DAPSA, DAS28-ESR) in an attempt to display discrepancies across these assessment tools for peripheral PsA. Methods: The study involved 758 patients (496 females, 262 males; mean age 47,1 years) with peripheral PsA who were registered to the Turkish League Against Rheumatism (TLAR) Network. The patients were assessed using the DAS28-ESR, DAPSA, MDA, and VLDA. The overall yield of each scale was assessed in identifying REM and LDA. The presence or absence of swollen joints was separately analysed. Results: The median disease duration was 4 years (range 0-44 years). According to DAPSA and DAS28-ESR, REM was achieved in 6.9% and 19.5% of the patients, respectively. The rates of MDA and VLDA were 16% and 2.9%, respectively. Despite the absence of swollen joints, a significant portion of patients were not considered to be in REM (296 (39.1%) patients with DAS28-ESR, 364 (48%) with DAPSA, and 394 (52%) with VLDA). Conclusion: Patients with peripheral PsA may be assigned to diverse disease activity levels when assessed with the DAS28-ESR, DAPSA, MDA and VLDA, which would inevitably have clinical implications. In patients with PsA a holistic approach seems to be necessary which includes other domains apart from joint involvement, such as skin involvement, enthesitis, spinal involvement, and patient-reported outcomes. (C) 2021 Societe franc , aise de rhumatologie. Published by Elsevier Masson SAS. All rights reserved.
  • [ X ]
    Öğe
    The Relationship Between Fatigue and Disease Activity as Determined by Different Indices in Patients with Psoriatic Arthritis (PsA)
    (Wiley, 2019) Duruoz, Mehmet Tuncay; Gezer, Halise Hande; Nas, Kemal; Kilic, Erkan; Sargin, Betul; Kasman, Sevtap Acer; Tuncer, Tiraje
    Background/Purpose: Fatigue is a substantial problem in patients with psoriatic arthritis (PsA) that needs to be considered in the core set of domains. This study aimed to evaluate the relationship between fatigue and disease activity levels as determined by various scales in patients with PsA. Methods: A total of 1134 patients (726 females, 408 males) diagnosed with PsA according to the CASPAR criteria were included (Turkish League Against Rheumatism (TLAR) Network multi-center study). Demographic features and clinical conditions of the patients were recorded. The following parameters were assessed: Maastricht Ankylosing Spondylitis Enthesis Score (MASES), Psoriasis Area and Severity Index (PASI), VAS fatigue (0-10 points: 0 – < 2 absent or mild, 2 – < 5 moderate, and 5 – 10 severe fatigue), Hospital Anxiety and Depression Scale (HAD), Fibromyalgia Rapid Screening Tool (FIRST). Disease activity was evaluated using the scores of DAS28, DAPSA, BASDAI, minimal disease activity (MDA), and very low disease activity (VLDA). The Spearman correlation coefficient was used for correlations. The Mann-Whitney U and chi-squared tests were used for between-group comparisons. A P value of less than 0.05 was considered to be statistically significant. Results: The mean age of the patients was 46.9 (SD:12.1) years, and the median disease duration was four years (range 0-44 years). The mean fatigue score was 4.9 (SD:2.8), being absent or mild, moderate, and severe fatigue in 14.8%, 24.9%, and 60% of the patients, respectively. The mean of women’s fatigue VAS was 5.4 (SD:2.7) while the men’s fatigue VAS mean was 4.01 (SD:2.7) (p< 0.05). Fatigue has good correlation with VAS-pain (rho: 0.595), FIRST (rho: 0.513), anxiety (rho: 0.436), depression (rho: 0.388), MASES (rho: 0.297) and it has poor correlation with PASI (rho: 0.073). DAS28 and DAPSA remission, MDA, and VLDA rates were 24.3%, 2.6%, 13.6%, and 2.3%, respectively. The fatigue score was significantly lower in patients with DAS28 remission, DAPSA remission, MDA and VLDA (p< 0.05) and fatigue has a significant correlation with disease activity levels on DAS28 and DAPSA (p< 0.05) (Table 1). The DAS28, DAPSA, and BASDAI scores showed significant between-group differences across the three severity groups of fatigue, being the highest disease activity among patients with severe fatigue (p< 0.05). Significantly higher FIRST, anxiety and depression scores were noted in patients with DAS28 remission and fatigue compared with patients in remission but no fatigue (p< 0.05). Conclusion: Fatigue is common and associated with disease activity, depression, anxiety, and fibromyalgia in PsA. Patients with remission, according to DAS28, DAPSA, and patients with MDA and VLDA have already mild to moderate fatigue.