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    Diagnostic delay in psoriatic arthritis: insights from a nationwide multicenter study
    (Springer Science and Business Media Deutschland GmbH, 2023) Kılıç, Gamze; Kılıç, Erkan; Tekeoğlu, İbrahim; Sargin, Betül; Cengiz, Gizem; Reşorlu, Hatice
    This study aimed to investigate the duration of diagnostic delay in patients with psoriatic arthritis (PsA) and identify potential contributing factors using a comprehensive, population-based approach. Data were obtained from the Turkish League Against Rheumatism (TLAR)-Network, involving patients who met the CASPAR criteria. Diagnostic delay was defined as time interval from symptom onset to PsA diagnosis, categorized as ≤ 2 years and > 2 years. Temporal trends were assessed by grouping patients based on the year of diagnosis. Various factors including demographics, clinical characteristics, disease activity, quality of life, physical function, disability, fatigue, and well-being were examined. Logistic regression models were used to identify factors associated with diagnostic delay. Among 1,134 PsA patients, mean diagnostic delay was 35.1 months (median: 12). Approximately 39.15% were diagnosed within 3 months, and 67.02% were diagnosed within 24 months. Patients experiencing longer delays had higher scores in Psoriatic Arthritis Quality of Life Questionnaire (PsAQoL), Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-Fatigue), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), patient’s global assessment (PtGA) and physician’s global assessment (PhGA). Diagnostic delay has decreased over time, with median delay falling from 60 to 24 months throughout pre-2010 and 2015–2019 terms. Several factors were identified as significant contributors to delayed diagnosis, including lower levels of education (OR = 2.63), arthritis symptoms preceding skin manifestations (OR = 1.72), low back pain at first visit (OR = 1.60), symptom onset age (OR = 0.96), and psoriasis subtype (OR = 0.25). Timely diagnosis of PsA is crucial for effective management and improved outcomes. Despite recent improvements, about one-third of PsA patients still experience delays exceeding 2 years. By identifying influential factors such as education level, arthritis symptoms preceding skin manifestations, initial visit symptoms, age of symptom onset, and psoriasis subtype, healthcare practitioners may create specific techniques to help in early detection and intervention.
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    The effect of gender on disease activity and clinical characteristics in patients with axial psoriatic arthritis
    (Oxford University Press, 2021) Nas, Kemal; Kiliç, Erkan; Tekeoğlu, İbrahim; Keskin, Yaşar; Çevik, Remzi; Sargin, Betül; Acer Kasman, Sevtap; Alkan, Hakan; Sahin, Nilay; Cengiz, Gizem; Cüzdan, Nihan; Albayrak Gezer, İlknur; Keskin, Dilek; Mülkoglu, Cevriye; Reşorlu, Hatice; Ataman, Şebnem; Bal, Ajda; Baykul, Merve; Duruöz, Mehmet Tuncay; Küçükakkaş, Okan; Yurdakul, Ozan Volkan; Alkan Melikoğlu, Meltem; Ayhan, Fikriye Figen; Bodur, Hatice; Çaliş, Mustafa; Çapkin, Erhan; Devrimsel, Gül; Gök, Kevser; Hizmetli, Sami; Kamanlı, Ayhan; Kocabaş, Hilal; Kutluk, Öznur; Şen, Nesrin; Şendur, Ömer Faruk; Toprak, Murat; Tolu, Sena; Tuncer, Tiraje
    Objectives: In this study, we aimed to evaluate the effect of gender on clinical findings, disease activity, functional status and quality of life in patients with axial involvement in Turkey. Methods: Patients with PsA who met the CASPAR classification criteria were enrolled consequently in this cohort. Turkish League Against Rheumatism (TLAR)-Network was formed with the participation of 25 centres. The demographic variables, fatigue, diagnostic delay, the beginning of peripheral arthritis, enthesitis, dactylitis and spine involvement, inflammatory low back pain, BASFI, HAQ, HAQ-s, visual analogue scale-pain (VAS-pain), anxiety, depression and disease activity parameters (ESR, DAS28, BASDAI) were recorded. Axial involvement was assessed according to clinical and radiological data according to modified New York (MNYC) or Assessment of SpondyloArthritis international Society (ASAS) criteria. Results: A total of 1018 patients with PsA were included in this study. Of the 373 patients with axial involvement, 150 were male (40.2%) and 223 (59.8%) were female. Spondylitis was detected in 14,7% of men and 21,9% of women in all patients. Pain score (VAS) (p < .002), fatigue (p < .001), ESR (p < .001), DAS28 (p < .001), BASDAI score (p < .001), PsAQoL (p < .001), HAQ score (p < ,01), HAQ-S score (p < .001), anxiety (p < .001), depression (p < .024), FACIT (p < .001) and FiRST (p < .001) scores were statistically significantly worse in women than males with axial PsA. However, quality of life was better (p < .001) and PASI score (p < .005) were statistically worse in male patients than in female patients with axial involvement. Conclusion: This study has shown that the burden of disease in axial PsA has significant difference between genders. Disease activity, physical disability, functional limitation, depression and anxiety scores were higher in female patients, while quality of life were better and PASI score were higher in male patients. Therefore, we suggest that new strategies should be developed for more effective treatment of axial PsA in female patients.