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Öğe Clinical characteristics, disease activity, functional status, and quality of life results of patients with psoriatic arthritis using biological and conventional synthetic disease-modifying antirheumatic drugs(Turkish League Against Rheumatism, 2021) Keskin, Yasar; Nas, Kemal; Kilic, Erkan; Sargin, Betul; Kasman, Sevtap Acer; Alkan, Hakan; Sahin, NilayObjectives: This study aims to compare the clinical characteristics, disease activity, and quality of life (QoL) of patients with psoriatic arthritis (PsA) who use biological and conventional synthetic disease-modifying antirheumatic drugs (DMARDs) in a nationwide cohort throughout Turkey. Patients and methods: A total of 961 patients (346 males, 615 females; mean age: 46.9+/-12.2 years; range, 18 to 81 years) with PsA according to the classification criteria for PsA were included in the study. The patients demographic and clinical characteristics, physical examination results, Disease Activity Score 28, Disease Activity Index for Psoriatic Arthritis and Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Psoriasis Area and Severity Index, Bath Ankylosing Spondylitis Functional Index, Bath Ankylosing Spondylitis Metrology Index, Hospital Anxiety and Depression Scale, Health Assessment Questionnaire, Psoriatic Arthritis Quality of Life (PsAQoL), and Short Form-36 scores were all recorded. Results: Of the patients, 23% underwent biological DMARD (bDMARD) monotherapy, 42% underwent conventional synthetic DMARD (csDMARD) monotherapy, 10% underwent a csDMARD combination therapy, and 10% underwent a combination bDMARD and csDMARD treatment. The Visual Analog Scale (VAS pain), patient global assessment, physician global assessment, and BASDAI scores were found to be lower among patients using combination treatment of csDMARD and bDMARD, while the swollen joint count was found to be lower among patients using bDMARD. The PsAQoL score was found to be the lowest among patients not using any medication and the highest among those using bDMARD. Conclusion: In our study, patients with PsA were successfully treated with both csDMARD and bDMARD monotherapy. When the biological treatments used for PsA were compared with csDMARD, it was found that biological treatments had a positive effect on both disease activity and the QoL. Combinations of csDMARDs and bDMARDs were preferred in cases in which the disease activity was still high or increased. Because of the highest efficacy of the combined treatment, we highly suggest increasing the number of patients on combined treatment.Öğe The effect of gender on disease activity, functional index and quality of life in patients with axial SPA. The data of tlar-network PSA study(Bmj Publishing Group, 2019) Nas, Kemal; Kılıç, Erkan; Tekeoğlu, İbrahim; Çevik, Remzi; Sargin, Betül; Kasman, Sevtap Acer; Tuncer, Tiraje…Öğe Enthesitis and its relationship with disease activity, functional status, and quality of life in psoriatic arthritis: a multi-center study(SPRINGER HEIDELBERG, 2020) Sunar, Ismihan; Ataman, Sebnem; Nas, Kemal; Kilic, Erkan; Sargin, Betul; Kasman, Sevtap Acer; Alkan, HakanPsoriatic arthritis (PsA) is an inflammatory arthritis with distinct phenotypic subtypes. Enthesitis is assigned as a hallmark of the disease, given its significant relations to disease activity and quality of life. Our objective is to evaluate the prevalence of enthesitis and its association with some clinical parameters, particularly quality of life, using data from a national registry. Patients with PsA meeting ClASsification criteria for Psoriatic Arthritis (CASPAR) were enrolled by means of a multi-centre Turkish League Against Rheumatism (TLAR) Network Project. The following information was recorded in web-based case report forms: demographic, clinical and radiographic data; physical examination findings, including tender and swollen joint counts (TJC and SJC); nail and skin involvement; Disease Activity Score-28 for Rheumatoid Arthritis with Erythrocyte Sedimentation Rate (DAS 28-ESR); Bath Ankylosing Spondylitis Disease Activity Index (BASDAI); Maastricht Ankylosing Spondylitis Enthesitis Score (MASES); Psoriasis Area Severity Index (PASI); Bath Ankylosing Spondylitis Radiology Index for the spine (BASRI-s); Health Assessment Questionnaire (HAQ); Bath Ankylosing Spondylitis Functional Index (BASFI); Health Assessment Questionnaire for the spondyloarthropathies (HAQ-s); Psoriatic arthritis quality of Life scale (PsAQoL); Short Form 36 (SF-36); Hospital Anxiety Depression Scale (HADS); Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F); and Fibromyalgia Rapid Screening Tool (FiRST) scores. The patients were divided into two groups, namely with and without enthesitis, based on the triple Likert-type physician-reported statement of 'active enthesitis', 'history of enthesitis' or 'none' in the case report forms. Patients with active enthesitis were compared to others in terms of these clinical parameters. A total of 1130 patients were enrolled in this observational study. Of these patients, 251 (22.2%) had active enthesitis according to the clinical assessment. TJC, HAQ-s, BASDAI, FiRST and PsAQoL were significantly higher whereas the SF-36 scores were lower in patients with enthesitis (p < 0.05). Chronic back pain, dactylitis, and tenosynovitis were more frequent in the enthesopathy group (59.4%/39%, 13.1%/6.5% and 24.7%/3.4%, respectively). Significant positive correlations between the MASES score and the TJC, HAQ, DAS 28-ESR, BASDAI, FiRST and PsAQoL scores, and a negative correlation with the SF-36 score were found. When linear regression analysis was performed, the SF-36 MCS and PCS scores decreased by - 9.740 and - 11.795 units, and the FiRST scores increased by 1.223 units in patients with enthesitis. Enthesitis is an important involvement of PsA with significant relations to quality of life determined with PsAQoL and SF-36 scores. Our study found higher frequency of dactylitis and chronic back pain, and worse quality of life determined with SF-36 and PsAQoL scores in patients with enthesitis.Öğe 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, TirajeBackground/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.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, HakanObjective: 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.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, HakanObjective: 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.Öğe Regional Difference in Disease Burden Among Patients with Psoriatic Arthritis: A Multi-Center Study(Wiley, 2019) Kilic, Erkan; Kilic, Gamze; Nas, Kemal; Sargin, Betul; Kasman, Sevtap Acer; Alkan, Hakan; Tuncer, Tiraje…Öğe Regional variations in psoriatic arthritis: Insights from a nationwide multicenter analysis in Türkiye(Turkish League Against Rheumatism, 2024) Kılıç, Erkan; Kılıç, Gamze; Tekeoğlu, İbrahim; Sargın, Betül; Kasman, Sevtap Acer; Alkan, Hakan; Sahin, NilayObjectives: The study aimed to investigate and compare clinical features, disease activity, and the overall disease burden among psoriatic arthritis (PsA) patients across seven distinct geographic regions in T & uuml;rkiye. Patients and methods: A multicenter cross-sectional study involving 1,134 PsA patients from 25 referral centers across seven regions was conducted. Demographic and clinical characteristics, comorbidities, joint involvement, extra-articular manifestations, and disease activity measures were evaluated across regions. Results: A total of 1134 PsA patients from seven different geographic regions in T & uuml;rkiye participated in this study. The highest number of participants was from the Marmara region (n=409), with subsequent representation from Central Anatolia (n=370), Aegean (n=139), Mediterranean (n=60), Black Sea (n=60), Eastern Anatolia (n=60), and Southeastern Anatolia (n=36) regions. There were significant variations in demographic profile, including age, body mass index, age of disease onset, educational status, comorbidities, and family history of both psoriasis and PsA. Clinical features, such as enthesitis, dactylitis, uveitis, and joint involvement, demonstrated significant variation across regions. Additionally, disease activity measures, including pain, patient and physician global assessments, acute phase reactants, disease activity indices, quality of life, and functional status, displayed considerable regional differences. Conclusion: This nationwide study revealed substantial regional diversity in demographic data, clinical characteristics, disease activity, and quality of life among PsA patients in T & uuml;rkiye. These findings stress the need to customize treatment approaches to address regional needs and to conduct further research to uncover reasons for disparities. It is crucial to enhance region-specific approaches to improve patient care and outcomes for PsA.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, TirajeBackground/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.Öğe The impact of nail psoriasis on disease activity, quality of life, and clinical variables in patients with psoriatic arthritis: A cross-sectional multicenter study(Wiley, 2023) Cengiz, Gizem; Nas, Kemal; Keskin, Yasar; Kilic, Erkan; Sargin, Betul; Kasman, Sevtap Acer; Alkan, HakanAim Nail involvement is common in psoriatic arthritis. This study assesses clinical characteristics, nail psoriasis prevalence, and impact of nail psoriasis on disease activity in patients with psoriatic arthritis (PsA). Method This cross-sectional multicenter study was conducted by the Turkish League Against Rheumatism using PsA patients recruited from 25 centers. Demographic and clinical characteristics of PsA patients, such as disease activity measures, quality of life, and nail involvement findings were assessed during routine follow-up examinations. Patients were divided into two groups according to the presence or absence of nail psoriasis and compared using the chi(2) test or Fisher exact test for categorical variables and the t-test or Mann-Whitney U test for continuous variables. Results In 1122 individuals with PsA, 645 (57.5%) displayed nail psoriasis. The most frequent features of fingernails were ridges (38%), followed by pitting (21%) and onycholysis (19%). More females were present in both groups (with and without nail psoriasis; 64% vs 67%, P < 0.282). Patients with nail psoriasis were older, indicated more pain and fatigue, experienced greater swelling, tender joint counts, and skin disease severity, and had a higher disease activity score compared with those without nail psoriasis (all P < 0.05). Conclusion We demonstrate an increased prevalence of nail psoriasis observed in patients with psoriatic arthritis. Patients with nail involvement experience increased disease activity, lower quality of life, and diminished mental and physical status compared with those without nail involvement.
