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Öğe Assessment of the New 2012 EULAR/ACR Clinical Classification Criteria for Polymyalgia Rheumatica: A Prospective Multicenter Study(J Rheumatol Publ Co, 2016) Ozen, Gulsen; Inanc, Nevsun; Unal, Ali Ugur; Bas, Seda; Kimyon, Gezmis; Kisacik, Bunyamin; Onat, Ahmet MesutObjective. To assess the performance of the new 2012 provisional European League Against Rheumatism (EULAR)/ American College of Rheumatology (ACR) polymyalgia rheumatica (PMR) clinical classification criteria in discriminating PMR from other mimicking conditions compared with the previous 5 diagnostic criteria in a multicenter prospective study. Methods. Patients older than 50 years, presenting with new-onset bilateral shoulder pain with elevated acute-phase reactants (APR), were assessed for the fulfillment of the new and old classification/diagnostic criteria sets for PMR. At the end of the 1-year followup, 133 patients were diagnosed with PMR (expert opinion) and 142 with non-PMR conditions [69 rheumatoid arthritis (RA)]. Discriminating capacity, sensitivity, and specificity of the criteria sets were estimated. Results. Discriminating capacity of the new clinical criteria for PMR from non-PMR conditions and RA as estimated by area under the curve (AUC) were good with AUC of 0.736 and 0.781, respectively. The new criteria had a sensitivity of 89.5% and a specificity of 57.7% when tested against all non-PMR cases. When tested against all RA, seropositive RA, seronegative RA, and non-RA control patients, specificity changed to 66.7%, 100%, 20.7%, and 49.3%, respectively. Except for the Bird criteria, the 4 previous criteria had lower sensitivity and higher specificity (ranging from 83%-93%) compared with the new clinical criteria in discriminating PMR from all other controls. Conclusion. The new 2012 EULAR/ ACR clinical classification criteria for PMR is highly sensitive; however, its ability to discriminate PMR from other inflammatory/noninflammatory shoulder conditions, especially from seronegative RA, is not adequate. Imaging and other modifications such as cutoff values for APR might increase the specificity of the criteria.Öğe Characteristics Predicting Tuberculosis Risk under Tumor Necrosis Factor-? Inhibitors: Report from a Large Multicenter Cohort with High Background Prevalence(J Rheumatol Publ Co, 2016) Kisacik, Bunyamin; Pamuk, Omer Nuri; Onat, Ahmet Mesut; Erer, Sait Burak; Hatemi, Gulen; Ozguler, Yesim; Pehlivan, YavuzObjective. Screening strategies for latent tuberculosis (TB) before starting tumor necrosis factor (TNF)-alpha inhibitors have decreased the prevalence of TB among patients who are treated with these agents. However, despite vigilant screening, TB continues to be an important problem, especially in parts of the world with a high background TB prevalence. The aim of this study was to determine the factors related to TB among a large multicenter cohort of patients who were treated with anti-TNF. Methods. Fifteen rheumatology centers participated in this study. Among the 10,434 patients who were treated with anti-TNF between September 2002 and September 2012, 73 (0.69%) had developed TB. We described the demographic features and disease characteristics of these 73 patients and compared them to 7695 patients who were treated with anti-TNF, did not develop TB, and had complete data available. Results. Among the 73 patients diagnosed with TB (39 men, 34 women, mean age 43.6 +/- 13 yrs), the most frequent diagnoses were ankylosing spondylitis (n = 38) and rheumatoid arthritis (n = 25). More than half of the patients had extrapulmonary TB (39/73, 53%). Six patients died (8.2%). In the logistic regression model, types of anti-TNF drugs [infliximab (IFX), OR 3.4, 95% CI 1.88-6.10, p = 0.001] and insufficient and irregular isoniazid use (<9 mos; OR 3.15, 95% CI 1.43-6.9, p = 0.004) were independent predictors of TB development. Conclusion. Our results suggest that TB is an important complication of anti-TNF therapies in Turkey. TB chemoprophylaxis less than 9 months and the use of IFX therapy were independent risk factors for TB development.Öğe Clinical Features of Takayasu's Arteritis from an Inception Cohort: Early Disease Is Characterized By 'systemic Inflammation'(Wiley, 2016) Alibaz-Oner, Fatma; Unal, Ali Ugur; Onat, Ahmet Mesut; Kisacik, Bunyamin; Zengin, Orhan; Karadag, Omer; Erden, Abdulsamet[Abstract Not Available]Öğe The Comparative One-Year Drug Survival Rate of Tumor Necrosis Factor Inhibitors in Patients with Rheumatoid Arthritis and Ankylosing Spondylitis; Results from Turkbio Registry(Clinical & Exper Rheumatology, 2014) Sari, Ismail; Kalyoncu, Umut; Onat, Ahmet Mesut; Pamuk, Omer Nuri; Karadag, Omer; Kisacik, Bunyamin; Senel, Soner[Abstract Not Available]Öğe The Comparative One-Year Drug Survival Rate of Tumor Necrosis Factor Inhibitors in Patients with Rheumatoid arthritis and ankylosing spondylitis; results from Turkbio Registry.(Wiley, 2014) Sari, Ismail; Kalyoncu, Umut; Onat, Ahmet Mesut; Pamuk, Omer Nuri; Karadag, Omer; Kisacik, Bunyamin; Krogh, Niels Steen[Abstract Not Available]Öğe Do impaired memory, cognitive dysfunction and distress play a role in methotrexate-related neutropenia in rheumatoid arthritis patients? A comparative study(Springer Heidelberg, 2013) Pamuk, Omer Nuri; Kisacik, Bunyamin; Pamuk, Gulsum Emel; Onat, Ahmet Mesut; Sayarlioglu, Mehmet; Donmez, Salim; Pehlivan, YavuzWe evaluated the roles of sociocultural status, distress and cognitive functions in rheumatoid arthritis (RA) patients who developed methotrexate (MTX)-related neutropenia. The data of 37 RA patients with MTX-related neutropenia who were being followed up at 3 centers were evaluated. The control group included 74 RA patients. The clinical features, biochemical tests and treatment modalities of the patients were obtained from hospital files. The mini-mental state examination (MMSE) test and the Hospital Anxiety and Depression Scale (HADS) were administered for all RA patients with neutropenia as well as the control group. The frequencies of male patients, illiterate patients, patients living alone, patients with serious visual impairment, those with low income, and patients with high creatinine were significantly higher among RA patients with MTX-related neutropenia than in controls (p values < 0.05). The RA patients with MTX-related neutropenia had significantly lower MMSE scores, and significantly higher HADS-A and HADS-D scores than controls (p values < 0.05). In addition, the proportion of patients with probable dementia was significantly higher in RA patients with MTX-related neutropenia than in controls (p < 0.001). Twenty-six of the 37 patients (70.3 %) developed neutropenia with daily dosing. Patients who used MTX daily were more likely to be living alone than those using weekly dosing (p = 0.011). Multivariate analysis showed that having probable dementia on the MMSE test (OR 52.6), low income level (OR 56.8) and age (OR 1.12) were independent risk factors for the development of MTX-related neutropenia. The presence of probable dementia on MMSE, low socioeconomical status and older age are associated with serious toxicity in RA patients using MTX. Measures should be taken to prevent wrong MTX dosing by the patients. Compliance and patient education is of major importance, in particular, in the patients presented in this study.Öğe Impacts of Anti-TNF Treatment on Improvement in Work Place and Household Productivity in Patients with Psoriatic Arthritis(Wiley, 2016) Karadag, Omer; Dalkilic, Ediz; Onat, Ahmet Mesut; Kucuksahin, Orhan; Kasifoglu, Timucin; Kisacik, Bunyamin; Pamuk, Omer Nuri[Abstract Not Available]Öğe The management of gout in different clinical specialties in Turkey: a patient-based survey(Springer London Ltd, 2016) Ozturk, Mehmet Akif; Mercan, Ridvan; Gok, Kevser; Onat, Ahmet Mesut; Kisacik, Bunyamin; Kimyon, Gezmis; Balkarli, AyseAlthough gout is potentially curable, the management of this disease is often suboptimal. In this study, we investigated the treatment of gout in Turkey and also compared the management approaches to gout in different clinical specialties. Three hundred and nineteen consecutive patients (mean age 58.60 +/- 12.8 years; 44 females, 275 males) were included in this multicenter study. A standardized form was generated to collect data about the patient's first admission to health care, the specialty of the doctor first diagnosed the gout, the treatment options for gout including attack management, patient referral, chronic treatment including medical treatment, and life style modifications. Forty patients were referred to another center without any treatment (12.8 %), and referral rate is most common among the primary care physicians (28.8 %). Colchicine was more commonly used for attack prophylaxis than allopurinol. Ninety-two patients had never been treated with allopurinol (28.8 %). Allopurinol prescription was less common among the primary care physicians and orthopedists, and highest among the rheumatologists. Recommendation of diet and life style modifications was less common among the primary care physicians and orthopedists, and highest among the rheumatologists. The rates of life style modification recommendation and long-term allopurinol prescription were 83.7 and 77.6 %, respectively, among the rheumatologists. Both acute and chronic management of gout is suboptimal in Turkey especially among the primary care physicians and orthopedists. Moreover, chronic treatment is even suboptimal among rheumatologists.Öğe Performance of the new American College of Rheumatology classification criteria in Turkish systemic sclerosis patients: a multicenter study(Springer London Ltd, 2016) Pamuk, Omer Nuri; Balci, Mehmet Ali; Onat, Ahmet Mesut; Zengin, Orhan; Cakir, Necati; Kisacik, BunyaminIn our study, we compared the sensitivity and specificity of the new ACR/EULAR 2013 criteria to the ACR 1980 criteria in our systemic sclerosis (SSc) population. Three rheumatology centers from Turkey participated into this study. The medical records of SSc patients diagnosed between 2008 and 2014 were retrospectively reviewed, and their features at disease onset were recorded. Patients admitted to each center within the same time period for conditions other than SSc, in whom ANA was positive and was deemed necessary within the diagnostic workup, were included as controls. One hundred and ninety-seven SSc patients (174 females, 23 males) and 103 controls (96 females, 7 males) were included. Limited cutaneous SSc was present in 68 % of patients, and 30.5 % had diffuse SSc. The sensitivity of ACR/EULAR 2013 and ACR 1980 criteria were, respectively, 94.4 and 85.3 % (p = 0.003). The specificity of ACR/EULAR 2013 and ACR 1980 criteria were, respectively, 98.1 and 100 %. According to the new criteria, 13 patients were misclassified; however, according to the ACR 1980 criteria, 29 patients were misclassified (p = 0.005). The sensitivity of ACR/EULAR 2013 criteria was significantly better than that of the ACR 1980 criteria in limited cutaneous SSc group (94.8 vs. 82.8 %). In patients whose disease duration was < 3 years, the new criteria had better sensitivity than the previous criteria (92.7 vs. 78.1 %, p = 0.006). The new ACR/EULAR 2013 criteria for SSc had better sensitivity in Turkish SSc patients, and less patients were misclassified.Öğe Short Term Efficacy of Tumor Necrosis Factor Inhibitors in Patients with non-radiographic Axial Spondylarthritis and ankylosing Spondylitis; Results from Turkbio Registry.(Wiley, 2014) Cetin, Pinar; Kalyoncu, Umut; Kisacik, Bunyamin; Sari, Ismail; Solmaz, Dilek; Karadag, Omer; Onat, Ahmet Mesut[Abstract Not Available]Öğe Tuberculosis Reactivation Risk in Patients Treated with Tumor Necrosis Factor Alpha Inhibitors: A Turkish Experience with Higher Mortality and Different Background Diseases.(Wiley, 2014) Kisacik, Bunyamin; Pamuk, Omer; Onat, Ahmet Mesut; Erer, B.; Hatemi, Gulen; Ozguler, Yesim; Pehlivan, Yavuz[Abstract Not Available]Öğe Validation of New 2012 EULAR/ACR Classification Criteria for Polymyalgia Rheumatica: Comparison with the Previous Criteria in a Prospective Multi-Center Study(Wiley, 2014) Ozen, Gulsen; Bas, Seda; Unal, Ali Ugur; Kimyon, Gezmis; Onat, Ahmet Mesut; Can, Meryem; Mengi, Alperen[Abstract Not Available]