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Öğe 2017 update of the Turkish League Against Rheumatism (TLAR) evidence-based recommendations for the management of knee osteoarthritis(SPRINGER HEIDELBERG, 2018) Tuncer, Tiraje; Cay, Fatih Hasan; Altan, Lale; Gurer, Gulcan; Kacar, Cahit; Ozcakir, Suheda; Atik, Sahap; Ayhan, Figen; Durmaz, Berrin; Eskiyurt, Nurten; Genc, Hakan; GokceKutsal, Yesim; Gunaydin, Rezzan; Hepguler, Simin; Hizmetli, Sami; Kaya, Taciser; Kurtais, Yesim; Saridogan, Merih; Sindel, Dilsad; Sutbeyaz, Serap; Sendur, Omer Faruk; Ugurlu, Hatice; Unlu, ZelihaIn a Turkish League Against Rheumatism (TLAR) project, evidence-based recommendations for the management of knee osteoarthritis (OA) was developed for the first time in our country in 2012 (TLAR-2012). In accordance with developing medical knowledge and scientific evidence, recommendations were updated. The committee was composed of 22 physical medicine and rehabilitation specialists (4 have rheumatology subspeciality also) and an orthopaedic surgeon. Systematic literature search were applied on Pubmed, Embase, Cochrane and Turkish Medical Index for the dates between January the 1st 2012 and January the 29th of 2015. The articles were assessed for quality and classified according to hierarchy for the level of evidence, and the selected ones sent to committee members electronically. They were asked to develop new recommendations. In the meeting in 2015, the format of the recommendations was decided to be patient-based and considering the grade and the severity of the disease. By the discussion of the each item under the light of new evidences, the final recommendations were developed. Each item was voted electronically on a 10-cm visual analogue scale (VAS) and the strength of recommendation (SoR) was calculated. In the light of evidences, totally 11 titles of recommendations were developed; the first 7 were applicable to each patient in every stages of the disease, remaining were for defined specific clinical situations. The mean SoR value of the recommendations was between 7.44 and 9.93. TLAR-2012 recommendations were updated in a new format. We think that, present recommendations will be beneficial for the physicians who manage, as well as the patients who suffer from the disease.Öğe Are plasma and synovial fluid leptin levels correlated with disease activity in rheumatoid arthritis ?(SPRINGER, 2007) Hizmetli, Sami; Kisa, Mustafa; Gokalp, Nurdagul; Bakici, M. ZahirLeptin is an adypocyte derivated peptide hormone that plays a major role in preventing obesity development by the effects at the hypothalamic level. In our study leptin levels of 41 rheumatoid arthritis (RA) patients and 25 healthy subjects as control group were assessed. Synovial fluid from 21 RA patients were collected to detect leptin levels. Synovial fluid and plasma leptin levels were analysed and correlated with RA duration, ESR, CRP, X ray changes (erosive or non-erosive disease) and negative or positive test for rheumatoid factor. There wasn't any significant difference at plasma leptin levels between RA patients (3.91 +/- 6.15) and control group (4.94 +/- 6.44) (p > 0.05). Plasma leptin levels were correlated with body mass index (BMI) in both healthy subjects and RA patients (r = 0.37; p = 0.018). Therefore in RA patients, plasma and synovial fluid leptin levels were not correlated with disease duration, ESR, CRP, negative or positive test for rheumatoid factor and erosive or non-erosive disease (p > 0.05). In conclusion leptin is correlated with BMI both in RA patients and healthy individuals but no considerable relation with disease activity.Öğe Association Between Familial Mediterranean Fever and Cachexia in Females(Turkish League Against Rheumatism, 2020) Durmaz, Yunus; Ilhanli, Ilker; Cengiz, Ahmet Kivanc; Kaptanoglu, Ece; Ozkan Hasbek, Zekiye; Hizmetli, SamiObjectives: This study aims to investigate the association between familial Mediterranean fever (FMF) and cachexia in females. Patients and methods: The study included 32 female FMF patients (median age 27.50 years; range, 18 to 50 years) and 30 female healthy controls (median age 32 years; range, 18 to 50 years). Patients were classified according to Tel-Hashomer criteria. Circumference of arm, waist, and thigh was recorded. Short form 36 (SF-36) and Multidimensional Assessment of Fatigue (MAF) scale were applied. Composition of the body was measured with dual X-ray absorption. Muscle strength was measured with an isokinetic dynamometer, and strength of hand grip was measured from dominant hand with a hand dynamometer. C-reactive protein, erythrocyte sedimentation rate, fibrinogen and serum creatinine kinase (CK) levels were recorded. Results: Body mass index was significantly higher in controls. Twelve patients and one control had cachexia. CK level was significantly higher in patients than controls. Mass of muscle without fat was significantly higher in patients than controls. Peak torque values of extension and flexion at the velocity of 60 degrees/second [Newton meter (Nm)], and value of total work during extension at the velocity of 240 degrees/second (Nm) in isokinetic measures were significantly higher in controls. MAF score was significantly higher in patients with cachexia than patients without cachexia where the subscale scores of SF-36, except the vitality score, were significantly lower in patients with cachexia. However, Tel-Hashomer score was significantly higher in patients with cachexia. Conclusion: This study pointed at a significant association between cachexia and FMF in females. Muscle endurance was not affected in FMF patients with cachexia; however, decreased muscle strength, impaired quality of life and increased fatigue were observed in these patients.Öğe Association of plasma homocysteine level and carotid intima-media thickness in rheumatoid arthritis patients receiving methotrexate(Turkish League Against Rheumatism (TLAR), 2015) Hayta, Emrullah; Hizmetli, Sami; Atalar, Mehmet Haydar; Çinar, ZiynetObjectives: This study aims to evaluate the relationship between serum homocysteine levels and atherosclerotic plaques in carotid arteries in female patients with rheumatoid arthritis (RA). Patients and methods: Fifty-eight females with RA (mean age 45.50±11.69 years; range 42 to 60 years) and 22 female controls (mean age 47.3±8.9 years; range 38 to 62 years) with mechanical low back pain were included in the study. RA patients were divided into two groups: patients who were under methotrexate (MTX) therapy at least for two years (MTX group, n=32), and patients who did not receive MTX at least for past two years (non-MTX-disease-modifying antirheumatic drug group, n=26). RA patients’ disease activity scores in 28 joints were calculated. Carotid intima-media thickness and presence of atherosclerotic plaque were evaluated by high-resolution B-mode ultrasonography. Results: Plasma homocysteine levels were higher in MTX and non-MTX-disease-modifying antirheumatic drug groups compared to controls (16.88±6.84 and 10.37±2.54 ?mol/L, respectively) and the difference was statistically significant (p=0.001). In MTX, non-MTX-disease-modifying antirheumatic drug and control groups, atherosclerotic plaque was detected in 11 (34.5%) and four (15.4%) patients, and one patient (4.5%), respectively. Carotid intima-media thickness was significantly higher in MTX group compared to other two groups and the difference was statistically significant (p=0.002). Pearson correlation analysis revealed a significant correlation between intima-media thickness and homocysteine levels in MTX group (r=0.49, p=0.006). Conclusion: According to our study results, methotrexate treatment in female patients with RA increases plasma homocysteine levels and prevalence of atherosclerotic plaque. High homocysteine levels in these patients may be a cause of atherosclerosis. © 2015 Turkish League Against Rheumatism. All rights reserved.Öğe Characteristics of Patients With Rheumatoid Arthritis in Turkey: Results From the Turkish League Against Rheumatism Rheumatoid Arthritis Registry(TURKISH LEAGUE AGAINST RHEUMATISM, 2015) Bal, Ajda; Ataman, Sebnem; Bodur, Hatice; Rezvani, Aylin; Paker, Nurdan; Tastekin, Nurettin; Karatepe, Altinay Goksel; Borman, Pinar; Yener, Mahmut; Nas, Kemal; Sezgin, Melek; Yazgan, Pelin; Tekeoglu, Ibrahim; Dogu, Beril; Altay, Zuhal; Kirnap, Mehmet; Gurgan, Alev; Gur, Ali; Hizmetli, Sami; Gunendi, Zafer; Erdem, Rana; Ugurlu, Hatice; Inal, Elem; Olmez, Nese; Kozanoglu, Erkan; Oken, Oznur; Ozel, Sumru; Dundar, Umit; Akinci, Aysen; Ozturk, Cihat; Sivrioglu, Koncuy; Duruoz, Mehmet Tuncay; Aydog, Ece; Capkin, Erhan; Altan, Lale; Evcik, Deniz; Durmus, Oguz; Yagci, Ilker; Sendur, Omer Faruk; Sertpoyraz, Filiz Meryem; Ozgul, Ahmet; Senel, Kazim; Capaci, KazimObjectives: This study investigates the demographic and clinical characteristics of patients with rheumatoid arthritis (RA) in Turkey, and attempts to identify strategies for the prevention, treatment, and support of RA. Patients and methods: A total of 2,359 patients (1,966 females, 393 males; mean age 51.6 +/- 12.5 years; range 18 to 75 years) with RA from 36 centers across Turkey, who were recorded in the Turkish League Against Rheumatism (TLAR) RA Registry between September 2007 and March 2011, were evaluated. Patients' demographic and clinical data were recorded. Disease activity, functional status, and radiographic damage were measured using the Disease Activity Score 28, the Health Assessment Questionnaire, and van der Heijde modified Sharp scoring method. Results: The mean duration of academic education received was 5.2 +/- 3.8 years, and 74.6% of the patients were homemakers. Non-biological disease-modifying anti-rheumatic drugs were used by 91.0% of the patients, while 10.2% used biological disease-modifying anti-rheumatic drugs. The mean Disease Activity Score 28, Health Assessment Questionnaire, and Sharp scores were 4.0 +/- 1.4, 0.38 +/- 0.37, and 31.2 +/- 57.1, respectively. Of the patients, 17.8% were in remission and 14.1% had low disease activity rates, while 42.7% and 25.5% had moderate and high disease activity rates. Conclusion: The majority of patients with RA in Turkey are middle-aged homemakers. Despite the high rates of disease-modifying anti-rheumatic drugs use, the majority of patients had moderate and high disease activity. These findings indicate that treatment needs of RA patients are not met sufficiently.Öğe Coexistence of Familial Mediterranean Fever and Juvenile Idiopathic Arthritis with Osteoporosis Successfully Treated with Etanercept(JAPAN SOC INTERNAL MEDICINE, 2010) Kaya, Sunay; Kaptanoglu, Ece; Elden, Hasan; Hizmetli, SamiFamilial Mediterranean fever (FMF) is an autoinflammatory disorder characterized by recurrent febrile polyserositis and arthritis attacks. Accompanying seronegative spondyloarthropathy has been reported in FMF in addition to its own joint involvement. However, the coexistence of FMF with juvenile idiopathic arthritis (JIA) is very rare, only three cases with severe joint involvement and mortal outcome have been reported in the literature. Here, we present another case with FMF and JIA with osteoporosis, successfully treated with etanercept with a four-year follow-up.Öğe Comparison of Beta-2 Adrenergic Receptor Gene Polymorphisms Between Patients With Fibromyalgia Syndrome and Healthy Controls(Turkish League Against Rheumatism, 2020) Sen Cakiro, Gozde; Hizmetli, Sami; Silig, Yavuz; Karadag, Ahmet; Hayta, Emrullah; Ozaltin, Burcu; Tas, AycaObjectives: This study aims to compare the beta-2 adrenergic receptor (ADRB2) gene polymorphisms of patients with fibromyalgia syndrome (FMS) with those of healthy control subjects, and to investigate the possible relationship between symptoms of FMS and polymorphisms of the ADRB2 gene. Patients and methods: The study included 170 females (mean age 47.8 +/- 10.3 years; range, 21 to 75 years) diagnosed with FMS according to the 2010 American College of Rheumatology criteria and 170 healthy females (mean age 47.2 +/- 8.8 years; range, 20 to 72 years) as the control group. Several clinical symptoms of the participants related to FMS were questioned and recorded. The visual analog scale (VAS) and Fibromyalgia Impact Questionnaire (FIQ) scores of the fibromyalgia group were recorded. In both groups, the ADRB2 (rs1042717) single-nucleotide polymorphism was detected by way of a real-time polymerase chain reaction. The wild-type (Guanine/Guanine), the mutant type (Adenine/Adenine) and heterozygous type (Adenine/Guanine) were detected. The sample power was calculated considering the minor allele frequency. Results: The comparison of the ADRB2 gene polymorphism between patients with FMS and the control subjects showed that the groups were similar in terms of ADBR2 gene polymorphism and genotype (p>0.05). There was no significant difference in terms of genotype when the ADRB2 gene polymorphisms in patients with FMS were compared in terms of clinical symptoms, VAS and FIQ scores (p>0.05). Conclusion: Beta-2 adrenergic receptor (rs1042717) gene polymorphisms and genotype distribution are no different between patients with FMS and healthy individuals. ADRB2 gene polymorphisms in patients with FMS have no effect on clinical symptoms and VAS and FIQ scores. The results of the present study will light the way for future research into ADRB2 gene polymorphisms in the pathogenesis of FMS.Öğe Complementary and Alternative Treatment Methods in Rheumatic Diseases(CLINICAL & EXPER RHEUMATOLOGY, 2014) Karadag, Ahmet; Kaptanoglu, Ece; Hayta, Emrullah; Konak, Akin; Hizmetli, Sami…Öğe Diagnostic value of autoantibodies against citrullinated peptide antigens in rheumatoid arthritis: Comparison of different commercial kits(Turkish League Against Rheumatism (TLAR), 2011) Şahin, Özlem; Kaptano?lu, Ece; Bakici, Mustafa Zahir; Sezer, Hafize; Elden, Hasan; Hizmetli, SamiObjectives: In this study we tested the diagnostic values of rheumatoid factor (RF), anti-cyclic citrullinated peptide (anti-CCP) and two different commercial anti-mutated citrullinated vimentin (anti-MCV) kits in the differential diagnosis of rheumatoid arthritis (RA) considering that there might also be substantial differences between the performances of the commercial kits. Patients and methods: Thirty-four RA patients, admitted to our rheumatology outpatient clinics between October 2008 and February 2009, and 24 healthy controls were included in this study. Sera of RA patients and healthy controls were analyzed for RF, anti-CCP-2, anti-MCV-548 and anti-MCV-248 autoantibodies with two different commercial kits. Disease activity was determined by disease activity score 28 (DAS-28) in RA patients. Extra-articular involvement was evaluated in RA patients. Results: In the receiver operating characteristic (ROC) curve analysis perfomed to determine the diagnostic sensitivity, anti-CCP-2 had the highest value of area under ROC curve. Sensitivity and specificity was 88% and 90%, 84% and 100%, 80% and 90%, and 84% and 100% for RF, anti-CCP-2, anti-MCV-548, and anti-MCV-248 respectively. DAS-28 had a weak correlation with anti-CCP-2 (r=0.623), anti-MCV-548 (r=0.481), and Anti-MCV-248 (r=0.408). There was no statistically significant difference in RF, anti-CCP-2, anti-MCV-548, and anti-MCV-248 values between patients with or without extra-articular involvement or between patients with low or moderate disease activity according to DAS-28 score. Conclusion: Anti-CCP, RF and anti-MCV autoantibodies are all useful in the differential diagnosis of RA. However, the anti-CCP antibody has a superior diagnostic value compared to the other auto antibodies. The anti-MCV antibodies detected by the anti-MCV-248 kit seem more reliable than the anti-MCV antibodies detected by the anti-MCV-548 kit in differential diagnosis of RA due to their high sensitivity and specificity. These findings suggest that different commercial kits may exhibit different performances. Nevertheless, our results need to be confirmed by future studies which should include more patients. © 2011 Turkish League Against Rheumatism. All rights reserved.Öğe Differentiation of rheumatoid arthritis from HCV infection: Rheumatoid factor, anti-cyclic citrullinated peptide or anti-mutated citrullinated vimentin?(Aves Yayincilik, 2010) Kaptano?lu, Ece; Nadir, Işilay; Bakici, Zahir; Hayta, Emrullah; Türkmen, Mehmet; Sezer, Hafize; Hizmetli, SamiObjective: Differentiation of rheumatoid arthritis (RA) from other diseases with joint involvement such as hepatitis-C virus (HCV) infection represents a diagnostic problem. In addition to the rheumatoid factor (RF), more specific and sensitive auto-antibodies are under evaluation in recent years with conflicting results. In this study, we tested the diagnostic value of rheumatoid factor, anti-cyclic citrullinated peptide (anti-CCP) and anti-mutated citrullinated vimentin (anti-MCV) in distinguishing RA from hepatitis C patients. Materials and Methods: Sera of 34 RA patients and 30 hepatitis C patients were tested for RF, anti-CCP anti-MCV. Disease activity was determined by disease activity score (DAS-28) 28 in RA and by modified Knodell score in hepatitis C patients. Extra-articular involvement in RA and rheumatologic involvement in hepatitis C patients were documented. Results: In roc analysis, area under curve (AUC) was the highest in anti-CCP. Sensitivity and specificity was 82% and 53%, 79%, and 96% and 70%, and 73% for RF, anti-CCP and anti-MCV respectively. DAS-28 has a weak correlation with RF (r=0.406), anti-CCP (r=0.433), and anti-MCV (r=0.453). There was no difference between the patients in autoantibody levels regarding extra-articular involvement and DAS-28 in RA, and joint involvement in hepatitis C patients. Conclusion: Anti-MCV antibodies may be useful in distinguishing RA however it seems to have no additional value over anti-CCP or RF in hepatitis C patients. Anti-CCP antibodies are more reliable in diagnosis of RA due to their high specificity.Öğe Differentiation of Rheumatoid Arthritis From HCV Infection: Rheumatoid Factor, Anti-Cyclic Citrullinated Peptide or Anti-Mutated Citrullinated Vimentin?(AVES YAYINCILIK, IBRAHIM KARA, 2010) Kaptanoglu, Ece; Nadir, Isilay; Bakici, Zahir; Hayta, Emrullah; Turkmen, Mehmet; Sezer, Hafize; Hizmetli, Sami; Elden, HasanObjective: Differentiation of rheumatoid arthritis (RA) from other diseases with joint involvement such as hepatitis-C virus (HCV) infection represents a diagnostic problem. In addition to the rheumatoid factor (RF), more specific and sensitive auto-antibodies are under evaluation in recent years with conflicting results. In this study, we tested the diagnostic value of rheumatoid factor, anti-cyclic citrullinated peptide (anti-CCP) and anti-mutated citrullinated vimentin (anti-MCV) in distinguishing RA from hepatitis C patients. Materials and Methods: Sera of 34 RA patients and 30 hepatitis C patients were tested for RF, anti-CCP anti-MCV. Disease activity was determined by disease activity score (DAS-28) 28 in RA and by modified Knodell score in hepatitis C patients. Extra-articular involvement in RA and rheumatologic involvement in hepatitis C patients were documented. Results: In roc analysis, area under curve (AUC) was the highest in anti-CCP. Sensitivity and specificity was 82% and 53%, 79%, and 96% and 70%, and 73% for RF, anti-CCP and anti-MCV respectively. DAS-28 has a weak correlation with RF (r=0.406), anti-CCP (r=0.433), and anti-MCV (r=0.453). There was no difference between the patients in autoantibody levels regarding extra-articular involvement and DAS-28 in RA, and joint involvement in hepatitis C patients. Conclusion: Anti-MCV antibodies may be useful in distinguishing RA however it seems to have no additional value over anti-CCP or RF in hepatitis C patients. Anti-CCP antibodies are more reliable in diagnosis of RA due to their high specificity. (Turk J Rheumatol 2010; 25: 19-23)Öğe Diffuse Alveolar Hemorrhage: A Life-Threatening Complication of Systemic Lupus Erythematosus(CLINICAL & EXPER RHEUMATOLOGY, 2014) Cengiz, Ahmet Kivanc; Durmaz, Yunus; Dinler, Mustafa; Dogan, Sevil Ceyhan; Hayta, Emrullah; Akin, Recep; Gumus, Cesur; Kaptanoglu, Ece; Hizmetli, Sami…Öğe Disease Activity, Fatigue and Quality of Life in Patients with Coexisting Ankylosing Spondylitis and Familial Mediterranean Fever(CLINICAL & EXPER RHEUMATOLOGY, 2014) Kaptanoglu, Ece; Cengiz, Ahmet Kivanc; Durmaz, Yunus; Hayta, Emrullah; Dogan, Sevil Ceyhan; Hizmetli, Sami…Öğe Does Mean Platelet Volume Really Reflect Disease Activity in Rheumatoid Arthritis?(CLINICAL & EXPER RHEUMATOLOGY, 2014) Hizmetli, Sami; Durmaz, Yunus; Cengiz, Ahmet Kivanc; Tuncay, Mehmet Siddik; Hayta, Emrullah; Dogan, Sevil Ceyhan; Kaptanoglu, Ece…Öğe Effect of Disease Duration and Activity and the Treatment Process on Central Sensitization in Patients with Ankylosing Spondylitis(2022) Guler, Emel; Doğancı, Alper; Gültürk, Esra; Artık, Hanzade Aybüke Ünal; Hizmetli, SamiObjective: Ankylosing spondylitis (AS) is a chronic inflammatory disease. Its main symptom is inflammatory low back pain. The presence of central sensitization (CS) in chronic pain conditions has been emphasized in several studies, but there are insufficient studies on AS patients. The aim of this study was to evaluate the relationship between disease activity in AS, the type of pain, and the presence of CS. Methods: Patients’ age, gender, body mass index, disease duration, drugs used in the treat ment, pain type and severity, presence of CS disease activity, and quality of life were evaluated. Results: Evaluation was made on 80 patients, comprising 49 (61.2%) females and 31 (38.8%) males. A statistical significance was found between the presence of CS and high scores of painDETECT, Bath Ankylosing Spondylitis Disease Activity Index, Numerical Rating Scale for pain, Ankylosing Spondylitis Disease Activity Index-sedimentation, Ankylosing Spondylitis Quality of Life Index, low Short-Form-12 (SF-12) physical score (***p<0.001), low SF-12 men tal score (**p<0.01), and increased age (* p<0.05). Conclusion: The results of this study demonstrated that as CS was present in the majority of AS patients, multidirectional evaluation of these patients is required, and in treatment approaches, evaluation is important in respect of treatments for CS in addition to the sup pression of inflammation.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; Kilic, Erkan; Tekeoglu, Ibrahim; Cevik, Remzi; Sargin, Betul; Kasman, Sevtap Acer; Alkan, Hakan; Sahin, Nilay; Cengiz, Gizem; Cuzdan, Nihan; Gezer, Ilknur Albayrak; Keskin, Dilek; Mulkoglu, Cevriye; Resorlu, Hatice; Ataman, Sebnem; Bal, Ajda; Duruoz, Mehmet Tuncay; Kucukakkas, Okan; Yurdakul, Ozan Volkan; Melikoglu, Meltem Alkan; Aydin, Yildiray; Ayhan, Figen; Bodur, Hatice; Calis, Mustafa; Capkin, Erhan; Devrimsel, Gul; Gok, Kevser; Hizmetli, Sami; Kamanli, Ayhan; Keskin, Yasar; Kocabas, Hilal; Kutluk, Oznur; Sen, Nesrin; Sendur, Omer Faruk; Toprak, Murat; Tolu, Sena; Tuncer, Tiraje…Öğe Evidence-Based Recommendations for the Management of Knee Osteoarthritis: A Consensus Report of the Turkish League Against Rheumatism(TURKISH LEAGUE AGAINST RHEUMATISM, 2012) Tuncer, Tiraje; Cay, Hasan Fatih; Kacar, Cahit; Altan, Lale; Atik, Osman Sahap; Aydin, Ahmet Turan; Ayhan, F. Figen; Yanik, Burcu Corekci; Durmaz, Berrin; Eskiyurt, Nurten; Genc, Hakan; Kutsal, Yesim Gokce; Gunaydin, Rezzan; Hepguler, Simin; Hizmetli, Sami; Kaya, Taciser; Kurtais, Yesim; Olmez, Nese; Saridogan, Merih; Sindel, Dilsad; Tur, Birkan Sonel; Sutbeyaz, Serap; Sendur, Omer Faruk; Ugurlu, Hatice; Unlu, ZelihaObjectives: Knee osteoarthritis (OA) is a common disease which causes pain, disability and great socioeconomic burden as a result. Turkish League Against Rheumatism (TLAR) initiated a project to prepare national, "evidence-based recommendations for the management of knee osteoarthritis" supported by expert-opinion in order to assist the physicians who are interested in knee OA in their daily clinical practice. Materials and methods: The expert committee was composed of 25 academicians, 23 of whom were physical medicine and rehabilitation (PM&R) specialists (three also had rheumatology subspeciality) and two were orthopedic surgeons. At the first meeting, the previous guidelines were discussed, and 2008 Osteoarthritis Research Society International (OARSI) recommendations were decided to be taken as the fundamental template for national recommendations. Databases of the Pubmed, Embase, Cochrane, and Turkish Medical Index were used to search the literature, and this was carried out for the period between 2009-2010 for international publications since studies up to 2009 were present in the 2010 OARSI update. No limit was applied for searching of national publications. The selected relevant publications were graded according to evidence level and quality, and were sent to the members who were then asked to suggest propositions according to their experiences, knowledge, and review of the literature. After amalgamation and editing of new proposals, Delphi rounds were started. After five Delphi rounds, the propositions on which the members were in consensus, were discussed with regard to evidence and the "strength of recommendation" was determined by measuring on visual analog scale (VAS) for each proposal at the final meeting. Results: Nineteen propositions (one for general principles, nine for non-pharmacologic treatments, seven for pharmacologic treatments, and two for surgical treatments) were accepted as the "TLAR Evidence-Based Recommendations for the Management of Knee OA" in consensus as a result of Delphi rounds. Conclusion: Evidence-based recommendations for the management of knee OA were developed by TLAR for the first time in our country. The recommendations should be updated regularly according to new evidence and insights. It is expected that physicians who are interested in knee OA will benefit greatly from this report in their daily clinical practice.Öğe The Frequency of the Clinical Risk Factors in Postmenopausal Osteoporosis(TURKISH LEAGUE AGAINST RHEUMATISM, 2013) Kutsal, Yesim Gokce; Savas, Serpil; Inanici, Fatma; Ozdemir, Oya; Karahan, Sevilay; Dogan, Asuman; Hizmetli, Sami; Kamanli, Ayhan; Kuran, Banu; Oncel, Sema; Sarikaya, Selda; Senel, Kazim; Ugurlu, Hatice; Yazgan, PelinObjectives: This study aims to identify the frequency of clinical risk factors associated with osteoporosis in postmenopausal women. Patients and methods: In this cross-sectional, observational, multicenter study, a total of 730 postmenopausal women were assessed for risk factors associated with osteoporosis. The assessment included a standardized questionnaire which recorded the following clinical risk factors: family and personal histories of fractures, prolonged immobilization, sun exposure, lifelong sedentary lifestyle, smoking history, low calcium intake in childhood and adulthood, excessive caffeine intake, high sodium intake, inadequate protein intake, number of pregnancies, age at menopause, the presence of premature menopause, primary and secondary amenorrhea, medical conditions, and chronic use of prescription drugs. Results: The most frequent clinical risk factors for osteoporosis were inadequate sun exposure (53.3%), current sedentary lifestyle (52.9%), low calcium intake in adulthood (45.1%) and childhood (41.9%), and sedentary lifestyle in adolescence (27.9%). A total of 707 patients (96.5%) described more than one risk factor, while 74.3% of the patients reported one clinical risk factor at least for secondary osteoporosis. Conclusion: Adequate sun exposure and proper intake of dietary calcium beginning in childhood combined with lifelong daily physical activity may play a role in preventing osteoporosis in postmenopausal women. In addition, physicians should be aware of the high probability of secondary osteoporosis in this patient group.Öğe High levels of cathepsin S and cystatin C in patients with fibromyalgia syndrome(Wiley, 2020) Kocak, Ibrahim; Hizmetli, Sami; Tas, Ayca; Karadag, Ahmet; Zontul, Cemile; Silig, YavuzObjectives Although the etiopathogenesis of fibromyalgia syndrome (FM) is not yet clear, central sensitization is thought to be responsible for the pathogenesis of FM. The aim of this study was to compare the serum cathepsin S (CatS) and cystatin C (CysC) levels between patients with FM and healthy control subjects. Methods This study was conducted in the Physical Medicine and Rehabilitation Clinic between January 2019 and October 2019. The study included 145 FM patients newly diagnosed with primary FM according to the 2010 American College of Rheumatology criteria and 129 healthy volunteers. The age, gender, and body mass index (BMI) of the participants were recorded. Venous blood samples were collected from both groups for the measurement of the levels of serum CatS and CysC. The functional status of FM patients was evaluated using the Fibromyalgia Impact Questionnaire (FIQ). Results No statistically significant difference was determined between the patient and control groups in terms of age, gender, and BMI (P > .05). A comparison of the serum CatS and CysC levels of the FM and control groups revealed a statistically significant difference (P = .001). No correlation was determined between FIQ and serum CatS and CysC levels (P > .05). Conclusion Serum CatS and CysC levels were found to be higher in FM patients. However, there was no correlation between the functional status of FM patients and serum CatS and CysC levels. These results can be of guidance for further clinical studies of the etiopathogenesis and treatment of FM.Öğe Hydroclimatology-Balneotherapy Practices in Elderly Patients(GALENOS YAYINCILIK, 2009) Hizmetli, SamiProgressive loss of biological productivity of the organism, difficulties in environmental compatibility and diminution in immune resistance mechanisms are what we call being old or elderliness. Today, elderliness and associated medical problems are observed as important social problems in both developed and developing countries. Therefore treatment of an old geriatric patient means a number of subsequent therapies varying from a nursing home with a geriatric program up to thermal cure centers and a large rehabilitation center. Thus various medical treatments administered in these centers, dietary interventions, exercise treatments applied together with physical therapy and a number of balneotherapy and hydrotherapy methods implemented in thermal cure centers are diminishing the disability ratios of the old geriatric patients and increasing their quality of life. Turk J Phys Med Rehab 2009; 55 Suppl 2: 100-3.
