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Öğe Assessment of loneliness in patients with inflammatory arthritis(Wiley, 2021) Emmungil, Hakan; Ilgen, Ufuk; Turan, Sezin; Kilic, OzgeAim This study aimed to explore loneliness and associated factors in Turkish patients with inflammatory arthritis. Method Adult patients with rheumatoid arthritis (RA) (n = 58), ankylosing spondylitis (AS) (n = 53), and psoriatic arthritis (PsA) (n = 30), respectively, were included in the study. A single-item visual analog scale (VAS) for loneliness, UCLA Loneliness Scale-8 (ULS-8), Beck depression inventory (BDI), Beck anxiety inventory (BAI), revised multidimensional scale of perceived social support, Health Assessment Questionnaire-Disability Index (HAQ-DI) were used for the psychometric and functional assessments. Multiple regression models were generated for predicting the ULS-8 and HAQ-DI scores. Results There was no difference between disease groups in terms of the ULS-8 and HAQ-DI scores. Among demographic and clinical parameters, only the education status and number of drugs used had associations with the ULS-8 score. Single-item VAS score for loneliness did not predict the ULS-8 score well. There were significant correlations between the ULS-8 and HAQ-DI, depression, anxiety, social support, and physician global VAS scores. Only the education status significantly predicted (beta = -0.208) the ULS-8 score in multiple regression analysis (adjusted R-2 = 0.15, P < .001). Beck depression, anxiety, and patient global VAS scores remained significant for predicting the HAQ-DI after multiple regression with the covariates ULS-8, depression, anxiety, social support, patient and physician global VAS scores, and the number of drugs used (adjusted R-2 = 0.53, P < .001). Disease activity and the ULS-8 scores were not found to be associated in any disease group. Conclusion Loneliness is associated with depression, anxiety, lack of social support, disability, higher number of drugs used, and lower education but not with disease activity in Turkish patients with RA, AS, and PsA. Perception and expression of loneliness vary according to the cultural background. Single-item scales for loneliness may lack reliability compared to the more comprehensive ULS-8.Öğe ASSESSMENT OF LONELINESS IN PATIENTS WITH INFLAMMATORY ARTHRITIS(Bmj Publishing Group, 2019) Emmungil, Hakan; Ilgen, Ufuk; Turan, Sezin; Kilic, Ozge[Abstract Not Available]Öğe Bull’s Head Sign in a Patient with SAPHO Syndrome(2019) İlgen, Ufuk; Turan, Sezin; Emmungil, Hakan[Abtract Not Available]Öğe Can Patient-Reported Outcomes and Disease Activity Scores Predict Patient Acceptable Symptom State in Adult-Onset Still's Disease?(Wiley, 2019) Bilgin, Emre; Kasifoglu, Timucin; Omma, Ahmet; Bes, Cemal; Cinar, Muhammet; Emmungil, Hakan; Kucuksahin, Orhan[Abstract Not Available]Öğe Colchicine Intolerance: Does the Pharmaceutical Preparation Matter?(Galenos Publ House, 2021) Ilgen, Ufuk; Emmungil, Hakan; Kucuksahin, Orhan[Abstract Not Available]Öğe Correlation Between Prognostic Nutritional Index and Primary Sjogren's Syndrome Disease Activity(Wiley, 2021) Kalkan, Kbra; Ilgen, Ufuk; Ademoglu, Zeliha; Emmungil, Hakan[Abstract Not Available]Öğe DERIVATION AND VALIDATION OF A NEW STILL ACTIVITY SCORE (SAS)(Bmj Publishing Group, 2019) Kalyoncu, Umut; Kasifoglu, Timucin; Omma, Ahmet; Bes, Cemal; Cinar, Muhammet; Emmungil, Hakan; Kucuksahin, Orhan[Abstract Not Available]Öğe Derivation and validation of adult Still Activity Score (SAS)(Elsevier France-Editions Scientifiques Medicales Elsevier, 2023) Kalyoncu, Umut; Kasifoglu, Timucin; Omma, Ahmet; Bes, Cemal; Cinar, Muhammet; Emmungil, Hakan; Kucuksahin, OrhanObjectives: Adult-onset Still's disease (AOSD) is a multi-systemic, autoinflammatory disorder. Several activity scores have been proposed but none of them have been adopted universally. Our aim was to create a clinician-friendly activity scoring system by using simple clinical and laboratory parameters.Methods: AODS patients, according to Yamaguchi criteria, were included in this cross-sectional, multi-center study. Derivation and validation cohorts were constituted. Demographic, clinical, and laboratory evaluation at the study visit; patients' and physicians' global assessments of disease activity (both VAS/Likert scale) were recorded. To develop the score, an ordinal logistic regression model was used to determine independent predictors of physicians' global assessments of disease activity. Clinically and statistically significant variables were weighted according to regression coefficients. Then, performance of the score was tested on the validation cohort. Results: A total of 197 consecutive AOSD patients (125 in derivation, 72 in validation cohorts) were included. Final Still Activity Score was fever (2 points), arthralgia (2 points, plus 1 point if arthritis was present in >= 2 joints), neutrophilia >= 65% (1 point) and ferritin >= 350 ng/mL (1 point) (maximum of 7 points). The SAS yielded an AUC value of 0.98 (0.96-1.00) in the derivation cohort and 0.91 (95%CI: 0.85-0.98) in the validation cohort to discriminate high AOSD activity from moderate-inactive AOSD. The correlation of SAS with PGA was 83% for the derivation cohort and 76% for the validation cohort. Conclusions: SAS has shown a good test performance to distinguish active AOSD patients from others. SAS may be a useful method for evaluating the disease activity of AOSD patients in daily practice.(c) 2022 Socie acute accent te acute accent franc , aise de rhumatologie. Published by Elsevier Masson SAS. All rights reserved.Öğe Different Colchicine Preparations for Familial Mediterranean Fever: Are They the Same?(Wiley, 2019) Emmungil, Hakan; Ilgen, Ufuk; Turan, Sezin; Yaman, Samet; Kucuksahin, Orhan[Abstract Not Available]Öğe Different pharmaceutical preparations of colchicine for Familial Mediterranean Fever: are they the same?(Springer Heidelberg, 2020) Emmungil, Hakan; Ilgen, Ufuk; Turan, Sezin; Yaman, Samet; Kucuksahin, OrhanThis study aimed to investigate the benefit of changing the pharmaceutical preparation of colchicine in Turkish Familial Mediterranean Fever (FMF) patients resistant to one preparation in terms of frequency of the attacks. Turkish adult FMF patients under treatment with an imported colchicine preparation-in the form of compressed tablet form-due to resistance to domestic colchicine preparations, which are film-or sugar-coated tablets, and not using anti-interleukin-1 or other biologic agents were included in the study. Baseline disease characteristics along with MEFV mutations were identified. Daily colchicine doses and attack frequencies before and after the pharmaceutical change were compared. Fifty patients resistant to coated tablet preparations of colchicine and under treatment with the compressed tablets were identified. The median duration of disease was 6 (interquartile range 2.7-14) years and duration under treatment with the imported colchicine was 21 (range 8-60) months. Eight (16%), ten (20%), and 32 (64%) patients had 0-3, 4-6, and more than 7 attacks per year, respectively, before the compressed tablets. After treatment with the compressed tablet form of colchicine, 44 (88%), 5 (10%), and 1 (2%) patients had 0-3, 4-6, and more than 7 attacks, respectively ( p < 0.0001). Daily colchicine doses were similar before and after the pharmaceutical change (1.85 +/- 0.47 vs 1.84 +/- 0.37 mg, p = 0.9). Turkish FMF patients with ongoing attacks under domestic coated tablet preparations of colchicine may benefit from the compressed colchicine tablets. This may be explained by the difference in pharmacokinetic properties of different colchicine preparations.Öğe EGFR blocker lapatinib inhibits the synthesis of matrix metalloproteinases from synovial fibroblasts(Tubitak Scientific & Technological Research Council Turkey, 2022) Kehribar, Demet Yalcin; Emmungil, Hakan; Turkmen, Nese Basak; Ciftci, Osman; Salva, Emine; Ozgen, MetinBackground/aim: Epidermal growth factor receptor (EGFR) family members and their associated ligands may be related to bone and joint destruction in rheumatoid arthritis. Matrix metalloproteinases are responsible for joint and bone tissue degradation. This study is intended to investigate the effect of epidermal growth factor receptor inhibition by lapatinib on the synthesis of matrix metalloproteinases in in vitro. Materials and methods: Synovial fibroblast cell culture was obtained from a patient with rheumatoid arthritis who underwent knee arthroplasty. Interleukin-1 beta (IL-1 beta) and tumor necrosis factor-alpha (TNF-alpha) were added to the cell culture to stimulate synovial fibroblast cells and create an inflammatory character. Understimulated and nonstimulated conditions, lapatinib was applied to the culture in four different concentrations of 25, 50, 100, and 200 mu mol. Then, matrix metalloproteinase -1, -3, and, -13 levels were assessed. Results: When stimulated with IL-1 beta and TNF-alpha, the synthesis of matrix metalloproteinases from synovial fibroblast was increased significantly. When lapatinib is added to the stimulated synovial fibroblasts, matrix metalloproteinases synthesis is significantly suppressed. Conclusion: Inhibition of the EGFR pathway with lapatinib suppresses matrix metalloproteinases synthesis. Our results suggest EGFR pathway inhibition may be a promising option to prevent joint destruction in the treatment of rheumatoid arthritis.Öğe Enteropathic Arthritis Beyond the Criteria(Oxford Univ Press Inc, 2022) Ilgen, Ufuk; Emmungil, Hakan[Abstract Not Available]Öğe Frequency of pulmonary hypertension in transthoracic echocardiography screening is not increased in Takayasu arteritis: Experience from a single center in Turkey(Aves, 2018) Kalfa, Melike; Emmungil, Hakan; Musayev, Oktay; Gunduz, Ozgul Soysal; Yilmaz, Zevcet; Inal, Vedat; Akar, Servet; Akkoc, Nurullah; Onen, Fatcs; Kayikcioglu, Meral; Keser, Gokhan; Aksu, KenanObjective: Pulmonary hypertension (PH) may occur in Takayasu arteritis (TA), mostly due to pulmonary arteritis, but also due to left heart disease and/or chronic thromboembolism (CTE). Using transthoracic echocardiography (TTE), we investigated the frequency of PH caused by pulmonary arteritis. Methods: This cross-sectional study include 70 patients with TA fulfilling the 1990 ACR criteria, 68 healthy controls, and 67 patients with systemic sclerosis (SSc) fulfilling the 1980 ACR criteria representing the disease control group. Patients with severe left heart disease or CTE were excluded. The ESC-ERS guideline definition was considered for diagnosis of PH. Results: The mean systolic pulmonary artery pressure (SPAP) values in TA, SSc, and healthy control groups were 20.93 +/- 606, 31.57 +/- 112.75, and 18.88 +/- 5.39 mmHg, respectively. While the SPAP values were similar between TA and healthy groups, the SPAP values in the SSc group were significantly higher than in other groups. Based on conventional and/or magnetic resonance angiography findings, pulmonary arteritis was present in 4 out of 70 TA patients; however, PH was not detected in any patients with TA, including those with pulmonary arteritis. Conclusion: The TTE findings suggested that the frequency of PH was not increased in TA. However, a low frequency of pulmonary arteritis in our series might have affected our results.Öğe GO-BEYOND: A REAL-WORLD PERSISTENCE STUDY WITH GOLIMUMAB IN PATIENTS WITH AXIAL SPONDYLOARTHRITIS AND RHEUMATOID ARTHRITIS IN TURKEY(Bmj Publishing Group, 2019) Akar, Servet; Kalyoncu, Umut; Dalkili, Ediz; Emmungil, Hakan[Abstract Not Available]Öğe GO-BEYOND: a real-world study of persistence of golimumab in patients with axial spondyloarthritis and rheumatoid arthritis in Turkey(Future Medicine Ltd, 2021) Akar, Servet; Kalyoncu, Umut; Dalkilic, Ediz; Emmungil, Hakan; Aziz, Ayten; Esen, Yasemin; Koc, TubaAim: To evaluate the retention rate of golimumab (GLM) in patients with rheumatoid arthritis (RA) and axial spondyloarthritis (ax-SpA). Materials & methods: Patients had received/were receiving GLM as their first or second biological drug for at least 3 months. We recorded demographic and clinical data, data on drug continuation and disease activity. Patients were classified as biologic-naive and biologic-experienced. Results: The study included 60 RA and 269 ax-SpA patients. At month 24, the retention rates were 67.2 and 57.1% (biologic-naive and biologic-experienced RA) and 74.8 and 80.4% (anti-TNF-naive and -experienced ax-SpA). No significant differences in retention were observed between the biologic-naive and -experienced groups for either disease. Conclusion: The results of this study confirm the effectiveness of GLM in the treatment of RA and axSpA with good retention rates at 2 years in a real-world setting in Turkey.Öğe Imaging in myositis: MRI or 18F-FDG PET/CT?(Springer London Ltd, 2022) Ilgen, Ufuk; Emmungil, Hakan[Abstract Not Available]Öğe The importance of speckle tracking echocardiography in the evaluation of cardiac functions in patients with rheumatoid arthritis(Turkish League Against Rheumatism, 2024) Ebik, Muserref; Tastekin, Nurettin; Gurdogan, Muhammet; Ebik, Mustafa; Birtane, Murat; Emmungil, Hakan; Yilmazer, BarisObjectives: In this study, we aimed to analyze the layer-specific strain values obtained by speckle tracking echocardiography (STE) method in the determination of subclinical cardiac dysfunction in rheumatoid arthritis (RA) patients. Patients and methods: Between February 2019 and October 2019, a total of 63 female RA patients (mean age: 51.82 +/- 6.07 years; range, 40 and 65 years) who had a confirmed diagnosis were included. Thirty-one age-matched female healthy individuals (mean age: 50.71 +/- 5.37 years; range, 40 and 65 years) were selected as the control group. The patients were divided into three groups according to the duration of disease as <5 years, 5-10 years and >10 years. The Disease Activity Score in 28 joint - C-reactive protein (CRP) was used to determine disease activation. The standard assessment included complete serum CRP, anti-cyclic citrullinated peptide, rheumatoid factor, N-terminal pro B-type natriuretic peptide (NT-proBNP), and homocysteine. Global longitudinal strain (GLS) analysis was performed with STE. Results: The NT-proBNP values were found to be higher in RA patients compared to the control group (p=0.044). In terms of conventional echocardiographic parameters, a significant difference between E/A and E/E' ratios was observed (p<0.001 and p=0.015). Endocardium, transmural, and epicardium GLS values obtained by STE were found to be lower in RA patients (p<0.05). The left ventricular (LV) GLS values worsened, as the duration of disease increased (p<0.05). There was a significant correlation between RA disease activity and LV GLS values, showing that increasing levels of disease activity was associated with worse LV GLS (r=0.583, p<0.01 and r=0.681, p<0.01 and r=0.689, p<0.01 for endocardium, transmural and epicardium, respectively). Conclusion: Our study results suggest that the layer-specific GLS values obtained by STE decrease in RA patients.Öğe Incidence of Cyclophosphamide-induced Urotoxicity and Protective Effect of Mesna in Rheumatic Diseasesle(J Rheumatol Publ Co, 2015) Yilmaz, Neslihan; Emmungil, Hakan; Gucenmez, Sercan; Ozen, Gulsen; Yildiz, Fatih; Balkarli, Ayse; Kimyon, GezmisObjective. To assess bladder toxicity of cyclophosphamide (CYC) and uroprotective effect of mesna in rheumatic diseases. Methods. Data of 1018 patients (725 women/293 men) treated with CYC were evaluated in this retrospective study. All of the following information was obtained: the cumulative CYC dose, route of CYC administration, duration of therapy, concomitant mesna usage, and hemorrhagic cystitis. Cox proportional hazard model was used for statistics. Results. We identified 17 patients (1.67%) with hemorrhagic cystitis and 2 patients (0.19%) with bladder cancer in 4224 patient-years. The median time for diagnosis to hemorrhagic cystitis was 10 months (4-48) and bladder cancer was 8 years (6-10.9). There were 583 patients (57.2%) who received mesna with intravenous CYC therapy. We observed similar incidence rate for hemorrhagic cystitis in both patient groups concomitantly treated with or without mesna [9/583 (1.5%) vs 8/425 (1.8%) respectively, p = 0.08]. Cumulative CYC dose (HR for 10-g increments 1.24, p < 0.001) was associated with hemorrhagic cystitis. Conclusion. Cumulative dose was the only risk factor for hemorrhagic cystitis in patients treated with CYC. No proof was obtained for the uroprotective effect of mesna in our cohort.Öğe Items of Yamaguchi Criteria Might be Associated with Disease Severity and Prognosis in Adult-Onset Still's Disease(Wiley, 2015) Kalyoncu, Umut; Solmaz, Dilek; Emmungil, Hakan; Yazici, Ayten; Kasifoglu, Timucin; Kimyon, Gezmis; Balkarli, Ayse[Abstract Not Available]Öğe A life-threatening haemoptysis case that would have been defined as idiopathic before the COVID-19 era(Turkish Assoc Tuberculosis & Thorax, 2021) Yilmam, Ilker; Karlikaya, Celal; Serez Kaya, Bilkay; Kula, Osman; Emmungil, HakanThe coronavirus disease 2019 (COVID-19) is characterized by respiratory infection which can show very different clinical pictures, somewhat changing medical paradigm. Hemoptysis defined as idiopathic can be seen as much as 15%. Currently, increasing hemoptysis cases are being reported in medical coronavirus literature. We here present a hemoptysis case that would be defined as idiopathic before the COVID-19 era. After the first clinical picture, the case turned into a life-threatening hemoptysis. We studied the case com-prehensively as clinical, pathogenetical, therapeutic and clinical practical aspects. Thus, we hypothesized that especially in the pandemic era, all hemoptysis cases must be evaluated as a possible life threatening infectious disease with unpredictable prognosis.
