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Öğe A multicenter report of biologic agents for the treatment of secondary amyloidosis in Turkish rheumatoid arthritis and ankylosing spondylitis patients(Springer Heidelberg, 2016) Pamuk, Ömer Nuri; Kalyoncu, Umut; Aksu, Kenan; Omma, Ahmet; Pehlivan, Yavuz; Çağatay, Yonca; Küçükşahin, Orhan; Dönmez, Salim; Çetin Yıldırım, Gözde; Mercan, Rıdvan; Bayındır, Özün; Çefle, Ayşe; Yıldız, Fatih; Balkarlı, Ayşe; Kılıç, Levent; Çakır, Necati; Kısacık, Bünyamin; Öksüz, Mustafa Ferhat; Çobankara, Veli; Onat, Ahmet Mesut; Sayarlıoğlu, Mehmet; Öztürk, Mehmet Akif; Pamuk, Gülsüm Emel; Akkoç, NurullahIn this multicenter, retrospective study, we evaluated the efficacy and safety of biologic therapies, including anti-TNFs, in secondary (AA) amyloidosis patients with ankylosing spondylitis (AS) and rheumatoid arthritis (RA). In addition, the frequency of secondary amyloidosis in RA and AS patients in a single center was estimated. Fifty-one AS (39M, 12F, mean age: 46.7) and 30 RA patients (11M, 19F, mean age: 51.7) with AA amyloidosis from 16 different centers in Turkey were included. Clinical and demographical features of patients were obtained from medical charts. A composite response index (CRI) to biologic therapy-based on creatinine level, proteinuria and disease activity-was used to evaluate the efficacy of treatment. The mean annual incidence of AA amyloidosis in RA and AS patients was 0.23 and 0.42/1000 patients/year, respectively. The point prevalence in RA and AS groups was 4.59 and 7.58/1000, respectively. In RA group with AA amyloidosis, effective response was obtained in 52.2 % of patients according to CRI. RA patients with RF positivity and more initial disease activity tended to have higher response rates to therapy (p values, 0.069 and 0.056). After biologic therapy (median 17 months), two RA patients died and two developed tuberculosis. In AS group, 45.7 % of patients fulfilled the criteria of good response according to CRI. AS patients with higher CRP levels at the time of AA diagnosis and at the beginning of anti-TNF therapy had higher response rates (p values, 0.011 and 0.017). During follow-up after anti-TNF therapy (median 38 months), one patient died and tuberculosis developed in two patients. Biologic therapy seems to be effective in at least half of RA and AS patients with AA amyloidosis. Tuberculosis was the most important safety concern.Öğe Large joint and lower extremity involvement have higher impact on disease outcomes in oligoarticular psoriatic arthritis(Wiley, 2020) Ayan, Gizem; Solmaz, Dilek; Bakırcı, Sibel; Tinazzi, Ilaria; Omma, Ahmet; Küçükşahin, Orhan; Özişler, Cem; Yavuz, Şule; Bayındır, Özün; Kimyon, Gezmiş; Doğru, Atalay; Tarhan, Emine Figen; Can, Meryem; Kılıç, Levent; Duruöz, Mehmet Tuncay; Aksu, Kenan; Kalyoncu, Umut; Aydın, Sibel ZehraObjective Joints with different sizes and anatomical locations can be affected in psoriatic arthritis (PsA). Our aim was to explore the effect of different joint patterns on patient-reported outcomes (PROs) in patients with mono-oligoarthritis. Methods Within PsArt-ID (Psoriatic Arthritis- International Database), 387/1670 patients who had mono-oligoarthritis (1-4 tender and swollen joints) were enrolled in cross-sectional assessment. The joints were categorized according to their size (small/large) and location (upper/lower extremity) and PROs, physician global assessment and C-reactive protein (CRP) were compared. Analysis was made by categorizing according to joint counts (1-2 joints/ 3-4 joints). Results The mean age (SD) was 46.9 (14.24) with a mean (SD) PsA duration of 3.93 (6.03) years. Within patients with 1-2 involved joints (n = 302), size of the joints only had an impact on CRP values with large joints having higher CRP (P = .005), similar to lower extremity involvement (P = .004). PROs were similar regardless of size or location if 1-2 joints were inflamed. Within patients with 3-4 involved joints (n = 85), patient global assessment (PGA), pain, fatigue and physician global assessment were higher in the group with large joints. Similarly, PGA, pain, and physician global assessment were higher in patients with lower extremity involvement as well as higher CRP values. Conclusion For PsA patients with 3-4 joints involved, lower extremity and large joints are associated with poorer outcomes with worse PROs, physician global assessment, and higher CRP. The size and anatomical location of the joints are less important for patients with 1-2 joints in terms of the PROs.Öğe Low relapse rate in patients with giant cell arteritis in a multi-centre retrospective Turkish Registry(2024) Alibaz Öner, Fatma; Keleşoğlu, Bahar; Balcı, Mehmet Ali; Yardımcı, Gözde Kübra; Armağan, Berkan; Kılıç, Levent; Karakaş, Özlem; Erden, Abdulsamet; Yaşar Bilge, Şule; Kardaş, Rıza Can; Küçük, Hamit; Zengin, Orhan; Taşçı, Murat; Kocaer, Sinem Burcu; Yavuz, Şule; Doğru, Atalay; Şahin, Mehmet; Bayındır, Özün; Sevik, Gizem; Ertürk, Zeynep; Alpay Kanıtez, Nilüfer; Göğebakan, Hasan; Tezcan, Mehmet Engin; Öksüz, Mustafa Ferhat; Çefle, Ayşe; Küçükşahin, Orhan; Yazıcı, Ayten; Kasapoğlu, Esen; Beş, Cemal; Ünal, Ali Uğur; Dalkılıç, Ediz; Yıldırım Çetin, Gözde; Aksu, Kenan; Keser, Gökhan; Önen, Fatoş; Çobankara, Veli; Kısacık, Bünyamin; Onat, Ahmet Mesut; Öztürk, Mehmet Akif; Kaşifoğlu, Timuçin; Omma, Ahmet; Karadağ, Ömer; Ateş, Aşkın; Direskeneli, HanerObjective Glucocorticoids (GC) are widely accepted as the standard first-line treatment for giant cell arteritis (GCA). However, relapse rates are reported up to 80% on GC-only protocol arms in controlled trials of tocilizumab and abatacept in 12-24 months. Herein, we aimed to assess the real-life relapse rates retrospectively in patients with GCA from Turkey. Methods We assembled a retrospective cohort of patients with GCA diagnosed according to ACR 1990 criteria from tertiary rheumatology centres in Turkey. All clinical data were abstracted from medical records. Relapse was defined as any new manifestation or increased acute-phase response leading to the change of the GC dose or use of a new therapeutic agent by the treating physician. Results The study included 330 (F/M: 196/134) patients with GCA. The mean age at disease onset was 68.9±9 years. The most frequent symptom was headache. Polymyalgia rheumatica was also present in 81 (24.5%) patients. Elevation of acute phase reactants (ESR>50 mm/h or CRP>5 mg/l) was absent in 25 (7.6%) patients at diagnosis. Temporal artery biopsy was available in 241 (73%) patients, and 180 of them had positive histopathological findings for GCA. For remission induction, GC pulses (250-1000 methylprednisolone mg/3-7 days) were given to 69 (20.9%) patients, with further 0.5-1 mg/kg/day prednisolone continued in the whole group. Immunosuppressives as GC-sparing agents were used in 252 (76.4%) patients. During a follow-up of a median 26.5 (6-190) months, relapses occurred in 49 (18.8%) patients. No confounding factor was observed in relapse rates. GC treatment could be stopped in only 62 (23.8%) patients. Additionally, GC-related side effects developed in 64 (24.6%) patients, and 141 (66.2%) had at least one Vasculitis Damage Index (VDI) damage item present during follow-up. Conclusion In this first multi-centre series of GCA from Turkey, we observed that only one-fifth of patients had relapses during a mean follow-up of 26 months, with 76.4% given a GC-sparing IS agent at diagnosis. At the end of follow-up, GC-related side effects developed in one-fourth of patients. Our results suggest that patients with GCA had a low relapse rate in real-life experience of a multi-centre retrospective Turkish registry, however with a significant presence of GC-associated side effects during follow-up.Öğe PsART-ID inception cohort: Clinical characteristics, treatment choices and outcomes of patients with psoriatic arthritis(Oxford University Press, 2021) Ayan, Gizem; Aydın, Sibel Zehra; Kimyon, Gezmiş; Özişler, Cem; Tinazzi, İlaria; Doğru, Atalay; Omma, Ahmet; Kılıç, Levent; Yılmaz, Sema; Küçükşahin, Orhan; Gönüllü, Emel; Yıldız, Fatih; Can, Meryem; Balkarlı, Ayşe; Solmaz, Dilek; Dalkılıç, Ediz; Bayındır, Özün; Yıldırım Çetin, Gözde; Ergülü Esmen, Serpil; Ersözlü, Emine Duygu; Duruöz, Mehmet Tuncay; Akyol, Lütfi; Küçük, Adem; Beş, Cemal; Çınar, Muhammet; Erden, Abdülsamet; Mercan, Rıdvan; Bakırcı, Sibel; Kaşifoğlu, Timuçin; Yazısız, Veli; Kalyoncu, UmutObjectives: Our aim is to understand clinical characteristics, real-life treatment strategies, outcomes of early PsA patients and determine the differences between the inception and established PsA cohorts.Methods: PsArt-ID (Psoriatic Arthritis- International Database) is a multicentre registry. From that registry, patients with a diagnosis of PsA up to 6 months were classified as the inception cohort (n==388). Two periods were identified for the established cohort: Patients with PsA diagnosis within 5-10 years (n = 328), ?10 years (n = 326). Demographic, clinical characteristics, treatment strategies, outcomes were determined for the inception cohort and compared with the established cohorts.Results: The mean (s.d.) age of the inception cohort was 44.7 (13.3) and 167/388 (43.0%) of the patients were male. Polyarticular and mono-oligoarticular presentations were comparable in the inception and established cohorts. Axial involvement rate was higher in the cohort of patients with PsA ?10 years compared with the inception cohort (34.8% vs 27.7%). As well as dactylitis and nail involvement (P = 0.004, P = 0.001 respectively). Both enthesitis, deformity rates were lower in the inception cohort. Overall, 13% of patients in the inception group had a deformity. MTX was the most commonly prescribed treatment for all cohorts with 10.7% of the early PsA patients were given anti-TNF agents after 16 months.Conclusion: The real-life experience in PsA patients showed no significant differences in the disease pattern rates except for the axial involvement. The dactylitis, nail involvement rates had increased significantly after 10 years from the diagnosis and the enthesitis, deformity had an increasing trend over time.Öğe Tocilizumab treatment in severe COVID-19: A multicenter retrospective study with matched controls(Springer Heidelberg, 2022) Mert, Ali; Vahaboğlu, Haluk; Arslan, Ferhat; Batirel, Ayşe; Saraçoğlu, Kemal Tolga; Baştuğ, Aliye; Çağatay, Atahan; Irmak, İlim; Telli Dizman, Gülçin; Ertenli, İhsan; Altunal, Lütfiye Nilsun; Ertürk Şengel, Buket; Bayram, Mehmet; Omma, Ahmet; Amikishiyev, Shirkhan; Aypak, Adalet; Bes, Cemal; Bölükçü, Sibel; İçten, Sacit; Topeli, Arzu; Bektaş, Murat; Arslan, Birsen Yiğit; Öztürk, Sinan; Çomoğlu, Şenol; Aydın, Selda; Küçükşahin, Orhan; İçaçan, Ozan Cemal; İnce, Burak; Aghamuradov, Sarvan; Yalçın Mutlu, Melek; Şimşek, Funda; Emre, Salih; Üstün, Cemal; Ergen, Pınar; Aydın, Özlem; Koç, Meliha Meriç; Sevindik, Ömür Gökmen; Odabaşı, Zekaver; Korten, Volkan; Bodur, Hürrem; Güner, Rahmet; Ünal, Serhat; Koçak, Mehmet; Gül, AhmetCoronavirus disease-2019 (COVID-19) associated pneumonia may progress into acute respiratory distress syndrome (ARDS). Some patients develop features of macrophage activation syndrome (MAS). Elevated levels of IL-6 were reported to be associated with severe disease, and anti-IL-6R tocilizumab has been shown to be effective in some patients. This retrospective multicenter case–control study aimed to evaluate the efficacy of tocilizumab in hospitalized COVID-19 patients, who received standard of care with or without tocilizumab. Primary outcome was the progression to intubation or death. PSMATCH (SAS) procedure was used to achieve exact propensity score (PS) matching.Data from 1289 patients were collected, and study population was reduced to 1073 based on inclusion–exclusion criteria. The composite outcome was observed more frequently in tocilizumab-users, but there was a significant imbalance between arms in all critical parameters. Primary analyses were carried out in 348 patients (174 in each arm) after exact PS matching according to gender, ferritin, and procalcitonin. Logistic regression models revealed that tocilizumab significantly reduced the intubation or death (OR 0.40, p = 0.0017). When intubation is considered alone, tocilizumab-users had > 60% reduction in odds of intubation. Multiple imputation approach, which increased the size of the matched patients up to 506, provided no significant difference between arms despite a similar trend for intubation alone group. Analysis of this retrospective cohort showed more frequent intubation or death in tocilizumab-users, but PS-matched analyses revealed significant results for supporting tocilizumab use overall in a subset of patients matched according to gender, ferritin and procalcitonin levels.
