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Öğe ANKYLOSING SPONDYLITIS HEALTH CARE COSTS AND ASSOCIATED DISEASE ACTIVITY SCORES IN TURKEY(Elsevier Science Inc, 2013) Akkoc, N.; Direskeneli, H.; Erdem, H.; Gul, A.; Kabasakal, Y.; Kiraz, S.; Durguner, B.; Baser, O.; Hamuryudan, VÖğe The cost of care of rheumatoid arthritis and ankylosing spondylitis patients in tertiary care rheumatology units in Turkey(Clinical & Exper Rheumatology, 2012) Malhan, S.; Pay, S.; Ataman, S.; Dalkilic, E.; Dinc, A.; Erken, E.; Ertenli, I.; Ertugrul, E.; Gogus, F.; Hamuryudan, V.; Inanc, M.; Karaaslan, Y.; Karadag, O.; Karakoc, Y.; Keskin, G.; Kisacik, B.; Kiraz, S.; Oksel, F.; Oksuz, E.; Pirildar, T.; Sari, I.; Soy, M.; Senturk, T.; Taylan, A.Objectives To determine the direct and indirect costs due to rheumatoid arthritis (RA) and ankylosing spondylitis (AS) patients in Turkey. Methods An expert panel was convened to estimate the direct and indirect costs of care of patients with RA and AS in Turkey. The panel was composed of 22 experts chosen from all national tertiary care rheumatology units (n=53). To calculate direct costs, the medical management of RA and AS patients was estimated using "cost-of-illness" methodology. To measure indirect costs, the number of days of sick leave, the extent of disability, and the levels of early retirement and early death were also evaluated. Lost productivity costs were calculated using the "human capital approach", based on the minimum wage. Results The total annual direct costs were 2,917.03 Euros per RA patient and 3,565.9 Euros for each AS patient. The direct costs were thus substantial, but the indirect costs were much higher because of extensive morbidity and mortality rates. The total annual indirect costs were 7,058.99 Euros per RA patient and 6,989.81 for each AS patient. Thus, the total cost for each RA patient was 9,976.01 Euros and that for an AS patient 10,555.72 Euros, in Turkey. Conclusion From the societal perspective, both RA and AS have become burden in Turkey. The cost of lost productivity is higher than the medical cost. Another important conclusion is that indirect costs constitute 70% and 66% of total costs in patients with RA and AS, respectively.Öğe THE COST OF CARE OF RHEUMATOID ARTHRITIS AND ANKYLOSING SPONDYLITIS PATIENTS IN TERTIARY CARE RHEUMATOLOGY UNITS IN TURKEY(Elsevier Science Inc, 2011) Malhan, S.; Pay, S.; Ataman, S.; Dalkilic, E.; Dinc, A.; Erken, E.; Ertenli, I; Ertugrul, E.; Gogus, F.; Hamuryudan, V; Inanc, M.; Karaaslan, Y.; Karadag, O.; Karakoc, Y.; Keskin, G.; Kisacik, B.; Kiraz, S.; Oksel, F.; Oksuz, E.; Parildar, T.; Sari, I; Soy, M.; Senturk, T.; Taylan, A.Öğe Impact of rheumatoid arthritis in Turkey: a questionnaire study(Clinical & Exper Rheumatology, 2014) Direskeneli, H.; Akkoc, N.; Bes, C.; Cakir, N.; Cefle, A.; Cobankara, V.; Dalkilic, E.; Dinc, A.; Ertenli, T.; Gul, A.; Hamuryudan, V.; Inanc, M.; Kalyoncu, U.; Karaaslan, Y.; Kasifoglu, T.; Keser, G.; Keskin, G.; Kisacik, B.; Kiraz, S.; Masatlioglu, S.; Onat, A. M.; Ozbek, S.; Ozturk, M. A.; Pamuk, O. N.; Pay, S.; Pirildar, T.; Sayarlioglu, M.; Senel, S.; Senturk, T.; Tasan, D.; Terzioglu, E.; Yazici, A.; Yucel, E.Objective Unmet needs of rheumatoid arthritis (RA) patients regarding physician/patient communication, treatment preferences and quality of life issues were investigated in a Turkish survey study. Methods The study was conducted with the contribution of 33 rheumatologists, and included 519 RA patients. The study population included patients who had been on biologic therapy for >6 months and were still receiving biologic therapy (BT group), and those who were biologic naive, but found eligible for biologic treatment (NBT group). Of the RA patients, 35.5% initially had a visit to an internal disease specialist, 25.5% to a physical therapy and rehabilitation specialist, and 12.2% to a rheumatology specialist for their RA complaints. The diagnosis of RA was made by a rheumatologist in 48.2% of patients. Results The majority of RA patients (86.3%) visit their doctor within 15-week intervals. Most of the physician-patient communication focused on disease symptoms (99.0%) and impact of the disease on quality of life (61.8%). The proportion of RA patients who perceived their health status as good/very good/excellent was higher in the BT group than in the NBT group (74.3% vs. 51.5%, p<0.001). However, of those RA patients in the NBT group, only 24.8% have been recommended to start a biologic treatment by their doctors. With respect to dose frequency options, once-monthly injections were preferred (80%) to a bi-weekly injection schedule (8%). Conclusion In conclusion, RA patients receiving biologic therapy reported higher rates of improved symptoms and better quality of life and seemed to be more satisfied with their treatment in our study.Öğe INDIRECT COSTS ASSOCIATED WITH ANKYLOSING SPONDYLITIS IN TURKEY(Elsevier Science Inc, 2012) Akkoc, N.; Direskeneli, H.; Erdem, H.; Gul, A.; Kabasakal, Y.; Kiraz, S.; Durguner, B.; Baser, O.; Hamuryudan, VÖğe INDIRECT COSTS ASSOCIATED WITH ANKYLOSING SPONDYLITIS IN TURKEY(Bmj Publishing Group, 2013) Akkoc, N.; Direskeneli, H.; Erdem, H.; Gul, A.; Kabasakal, Y.; Kiraz, S.; Durguner, B.; Baser, O.; Hamuryudan, V.Öğe Interleukin (IL)-12, IL-2, and IL-6 gene polymorphisms in Takayasu's arteritis from Turkey(Elsevier Science Inc, 2006) Saruhan-Direskeneli, G.; Bicakcigil, M.; Yilmaz, V.; Kamali, S.; Aksu, K.; Fresko, I.; Akkoc, N.; Kiraz, S.; Ozer, H. T. E.; Tunc, E.; Yucel, E.; Karaarslan, Y.; Uyar, F. A.; Doganavsargil, E.; Inanc, M.; Direskeneli, H.Takayasu's arteritis (TA) is a chronic arterial inflammation of unknown etiology involving mainly the aorta and its major branches. Genetic polymorphisms of cytokines are screened as susceptibility factors for TA in Turkey. A total of 94 patients with TA were investigated for the genetic polymorphisms of the interleukin genes IL12, IL2,and IL6 and were compared with 108 healthy control subjects using polymerase chain reaction-sequence-specific primer method. The frequencies of IL12B 1188 C allele (p = 0.03, OR = 1.7) and CC genotype (p = 0.007, OR = 3.7) were both higher in TA patients than in control subjects. TT genotype at IL2-330 (p = 0.006, OR = 2.4) and GG genotype at IL6-174 (p = 0.04, OR = 1.9) were more frequent in TA patients. Lower prevalence of GT genotype at IL2-330 (P = 0,005, OR = 0.4), CG genotype at IL6-174 (p = 0.001, OR = 0.4), and AG genotypes at IL6-598 (p = 0.01, OR = 0.4) were also detected. The polymorphism of IL-12 as well as IL-6 and IL-2 genes may contribute to susceptibility and pathogenesis of TA by altering cytokine production and inducing inflammation. (c) American Society for Histocompatibility and Immunogenetics, 2006. Published by Elsevier Inc.Öğe PDCD1 polymorphisms are not associated with Takayasu's arteritis in Turkey(Clinical & Exper Rheumatology, 2012) Direskeneli, H.; Tuna-Erdogan, E.; Gunduz, F.; Bandurska-Luque, A.; Alparslan, B.; Kebe, M.; Uyar, F. A.; Bicakcigil, M.; Aksu, K.; Kamali, S.; Ozbalkan, Z.; Ates, A.; Karadag, O.; Ozer, H. T. E.; Akar, S.; Onen, F.; Seyahi, E.; Onat, A. M.; Aydin, S. Z.; Yilmaz, N.; Cefle, A.; Cobankara, V.; Tunc, E.; Ozturk, M. A.; Fresko, I.; Karaaslan, Y.; Akkoc, N.; Yucel, A. E.; Kiraz, S.; Keser, G.; Inanc, M.; Saruhan-Direskeneli, G.Objectives. Takayasu's arteritis (TA) is a chronic arterial inflammation of unknown etiology involving mainly the aorta and its major branches. Based on the associations of programmed death-1 (PD-1) protein encoding gene (PDCD1) with connective tissue diseases and vasculitides, PDCD1 polymorphisms are studied for susceptibility to TA in this study. Methods. The study group is made up of TA patients (n=229) fulfilling the 1990 ACR classification criteria and compared to 193 healthy controls (HC). PD-1.3, PD-1.5 and PD-1.6 single nucleotide polymorphisms of PDCD1 gene are genotyped by polymerase chain reaction and restriction analysis (PCR-RFLP). Results. The distribution of PD-1.5 polymorphism in TA patients and HC revealed a similar presence of TT genotype in patients and controls (13.3% vs. 11.4%). PD-1.3 and PD-1.6 were less polymorphic and did not differ between the groups. Rare AA genotype of PD-1.3 (1.4% vs. 1.0%) and AG genotype of PD-1.6 was again similarly (22.4% vs. 19.2%) present in TA and HC. Conclusion. PD-1.3, 1.5 and 1.6 polymorphisms of PDCD1 gene, which were shown to be associated with various autoimmune disorders and vasculitides, are not associated with a susceptibility to TA in Turkish population.Öğe PRODUCTIVITY LOSS DUE TO SICK LEAVE IN PATIENTS WITH ANKYLOSING SPONDYLITIS(Bmj Publishing Group, 2013) Akkoc, N.; Direskeneli, H.; Erdem, H.; Gul, A.; Kabasakal, Y.; Kiraz, S.; Durguner, B.; Hamuryudan, V.Öğe Remarkable damage along with poor quality of life in Takayasu arteritis: cross-sectional results of a long-term followed-up multicentre cohort(Clinical & Exper Rheumatology, 2017) Omma, A.; Erer, B.; Karadag, O.; Yilmaz, N.; Alibaz-Oner, F.; Yildiz, F.; Kalfa, M.; Kimyon, G.; Kiraz, S.; Direskeneli, H.; Erken, E.; Aksu, K.; Onat, A. M.; Gul, A.; Ocal, L.; Inanc, M.; Kamali, S.Objective. We aimed to assess the outcome of a large Takayasu arteritis (TAK) cohort using the vasculitis damage index (VDI) and quality of life (QoL) scale, tools which have been validated for vasculitis. Methods. Disease activity, damage and QoL were cross-sectionally evaluated in 165 TAK patients from 6 centres. SF-36 were applied to 51 age-matched healthy controls (HC). Persistent activity for months was considered as treatment resistance (r-TAK). The correlation between VDI, clinical characteristics and mental (MCS)/physical (PCS) component scores of SF-36 were analysed. SF-36 and VDI scores were compared between TAK subgroups and HC. Results. The median age, follow-up time and disease duration were 40 (17-68), 60 (6-384), and 72 (6-396) months, respectively. 35% of them were r-TAK. VDI scores (VDIs) in TAK 4 (1-12) were mainly due to the disease itself [4 (1-10)]. VDIs in r-TAK were significantly higher than nr-TAK [5 (212) vs. 3 (2-10), p<0.001)1. In the TAK patients, MCS and PCS were found as 43 10 and 38 11, respectively. A high proportion of poor MCS (70%) and PCS (80%) were demonstrated in TAK. A significantly negative but weak correlation was observed between VDI and MCS (p=0.003, r=-0.23), PCS (p<0.001, r=-0.34). Higher VDIs were detected in patients with PCS <50 [5 (.1-12) vs. 2 (1-6) p<0.001)]. SF-36 score was significantly lower in TAK than KC. Conclusion. Disease-related damage mainly caused by peripheral vascular involvement was more predominant than treatment-related damage without reaching the level of severe damage scores, but contributing to poor QoL, in the TAK cohort.Öğe Takayasu's arteritis in Turkey - clinical and angiographic features of 248 patients(Clinical & Exper Rheumatology, 2009) Bicakcigil, M.; Aksu, K.; Kamali, S.; Ozbalkan, Z.; Ates, A.; Karadag, O.; Ozer, H. T. E.; Seyahi, E.; Akar, S.; Onen, F.; Cefle, A.; Aydin, S. Z.; Yilmaz, N.; Onat, A. M.; Cobankara, V.; Tunc, E.; Ozturk, M. A.; Fresko, I.; Karaaslan, Y.; Akkoc, N.; Yuecel, A. E.; Kiraz, S.; Keser, G.; Inanc, M.; Direskeneli, H.Objective. Takayasu's arteritis (TA) is a chronic, inflammatory vasculitis affecting the aorta and its major branches. Although it is more, prevalent in Far-East Asia, the distribution of the disease is worldwide with different vascular involvement patterns and clinical manifestations. The objective of this study was to evaluate the demographic, clinical, angiographic and prognostic features of TA patients in Turkey. Methods. Clinical and angiographic findings of 248 TA patients (228 female, 27 male)followed at 15 Rheumatology Centers were prospectively evaluated according to a predefined protocol. Results. The mean age was 40.1 years (30.2 years at the clinical onset). Clinical manifestations included constitutional symptoms in 66%, absent or diminished pulses in 88%, bruits in 77%, extremity pain in 69%, claudication in 48%, hypertension in 43% and cerebrovascular accidents (CVA) in 18% of the patients. Renal artery stenosis, aortic regurgitation and pulmonary hypertension were present in 26%, 33% and 12%, respectively. According to the new angiographic classification, type V (50.8%) and Type I (32%) were the most frequent types of involvement. Corticosteroids were the main treatment in 93% of the patients alone (9%) or in combination with immunosuppressive agents (84%). Most frequently preferred immunosuppressive agents were methotrexate (63%), azathioprine (22%) and cyclophosphamide (13%). Remission was observed at least once in 94% of the patients and sustained remission in 71% during follow-up. Conclusion. The demographical, clinical and angiographic findings of TA patients in our series were similar to those reported from Japan, Brazil and Colombia. Combination therapies with immunosuppressive agents were the preferred choice of treatment in Turkey.
