Merih Birlik - Academia.edu (original) (raw)

Papers by Merih Birlik

The Turkish Journal of Gastroenterology, 2018

Background/Aims: To translate the University of California, Los Angeles Scleroderma Clinical Tria... more Background/Aims: To translate the University of California, Los Angeles Scleroderma Clinical Trial Consortium Gastrointestinal Tract (UCLA SCTC GIT) 2.0 questionnaire from English to Turkish and to validate it. Materials and Methods: UCLA SCTC GIT 2.0 was translated into Turkish using the translation-retranslation method. The available Turkish GIT 2.0 and the Short Form 36 (SF-36) were administered to 97 Turkish-speaking patients with systemic sclerosis (Ssc). Internal consistency reliability and structural validity were assessed by analyzing the correlations between the UCLA SCTC GIT 2.0 and the SF-36 scales. Internal consistency was determined by calculating Cronbach's alpha. For evaluation of reliability, the questionnaire scale was repeatedly applied to a subgroup of patients with a 2-week interval, and the intraclass correlation coefficient (ICC) was calculated. The Spearman's correlation coefficients between the GIT and the SF-36 scores were calculated. Results: A group of 97 patients with Ssc with a mean age of 55.37±11.35 years and a female predominance (87.6%) were included in the study. The Cronbach's alpha value for the UCLA SCTC GIT 2.0 scale was 0.894. ICC was 0.821 (p=0.000). The scale showed acceptable reliability, with the exception of the diarrhea subscale (alpha=0.356). There was a moderate correlation between the total GIT score and the Short Form 36 (SF-36) subscales. All of the items in the scale were included in the validity analysis owing to their reliability. Conclusion: The Turkish GIT 2.0 scale showed good internal consistency, high reliability, and an acceptable validity.

Turkish Journal of Medical Sciences, Aug 30, 2021

Background/aim: This study aimed to investigate the prevalence of sicca symptoms and secondary Sj... more Background/aim: This study aimed to investigate the prevalence of sicca symptoms and secondary Sjögren's syndrome (SjS) in patients with systemic sclerosis (SSc). Also this study aimed to evaluate the expression of α-smooth muscle actin (α-SMA) in minor salivary gland (MSG) specimens, a possible marker of fibrosis responsible for myofibroblastic transformation. Materials and methods: Patients with SSc who were followed in Rheumatology outpatient clinic at a university hospital evaluated. The questionnaire of sicca symptoms and classification of SjS were evaluated according to the American-European Consensus Group (AECG) criteria. Histopathologic evaluations were done in MSG specimens investigating the presence of focal lymphocytic sialadenitis and glandular fibrosis, also assessing the expression of α-SMA. Results: This cross-sectional study included 102 patients with SSc [91 females (89%), mean age 52.5 ± 12 years]. In this cohort 76 (75%) patients had sicca symptoms and 36 (35.3%) patients fulfilled the AECG criteria for SjS; all with limited form. Having SjS found to be associated with older age and the presence of positive anti-SS-A antibodies. On histopathologic examinations, glandular fibrosis was observed in 67 (80%) and lymphocytic sialadenitis was detected in 38 (45%) patients; but only 7 samples were positive for α-SMA. Conclusion: This study suggested sicca symptoms were found to be very common among patients with SSc. Also secondary SjS was detected in nearly one-third of patients with SSc; especially in limited subtype. Anti SS-A positivity and older age were detected as predictors for SjS. Histopathologic evaluations showed significant glandular fibrosis but rare α-SMA staining in patients with SSc.

Scandinavian Journal of Rheumatology, Jun 6, 2022

Rheumatology International, Jul 5, 2023

Wiener Klinische Wochenschrift, Sep 26, 2022

Clinical Rheumatology, Feb 8, 2021

To determine limited joint mobility (LJM) of the hand in patients with systemic sclerosis (SSc). ... more To determine limited joint mobility (LJM) of the hand in patients with systemic sclerosis (SSc). LJM was evaluated with “prayer sign” and “tabletop sign” tests. LJM staging was done by Rosenbloom classification method. LJM (+) and LJM (−) patients were compared in terms of demographic findings (gender, age and duration of disease), laboratory results (ESR, CRP, anti-nuclear antibody (ANA), anti-topoisomerase I and anti-centromere), and modified Rodnan skin score (mRss) results. In our study, a total of 217 patients, including 113 patients with a diagnosis of SSc, and 104 as a healthy control group with similar age and gender distribution to these patients, were included. A total of 113 (F=98, M=15) patients (limited cutaneous SSc (lcSSc=71), diffuse cutaneous SSc (dcSSc=42)) were included in this study and LJM positivity was found in 66.4% (lcSSc=38, dcSSc=37). A statistically significant difference was observed in between lcSSc and dcSSc patients according to the presence of LJM (p<0.001). There was a moderate positivity relationship between LJM and mRss (lcSSc r=0.449, p<0.001; dcSSc r=0.565, p<0.001). In our study, it was found that LJM staging correlated with mRss and dcSSc patients had more severe LJM findings than lcSSc. We conclude that “prayer sign” and “tabletop sign” tests used in hand evaluation in SSc patients have similar clinical results with mRss and can be simple bedside tests in daily practice. Key Points • This is the first study examining limited joint mobility (LJM) with “prayer sign” and “tabletop sign” tests in systemic sclerosis (SSc) patients. • “Prayer sign” and “tabletop sign” tests can be easily performed in daily practice. • We found Rosenbloom LJM staging correlated with modified Rodnan skin score. LJM of the hand can be a good prognostic indicator for early stage SSc patients. Key Points • This is the first study examining limited joint mobility (LJM) with “prayer sign” and “tabletop sign” tests in systemic sclerosis (SSc) patients. • “Prayer sign” and “tabletop sign” tests can be easily performed in daily practice. • We found Rosenbloom LJM staging correlated with modified Rodnan skin score. LJM of the hand can be a good prognostic indicator for early stage SSc patients.

Journal of Infection in Developing Countries, Jul 27, 2023

Introduction: We aimed to investigate the effects of the coronavirus disease 2019 (COVID-19) pand... more Introduction: We aimed to investigate the effects of the coronavirus disease 2019 (COVID-19) pandemic on the course and treatment of patients with inflammatory rheumatic musculoskeletal disease (iRMD) using biologic or targeted synthetic disease modifying and rheumatic drugs (b/tsDMARDs). Methodology: The study was carried out in two stages: in the first stage we investigated the delay of b/tsDMARD treatment in the first 3 months of the pandemic; in the second stage, we investigated all patients who decided to continue treatment after interruption in the 12-month period. Results: A total of 521 patients were included in the study. The iRMD diagnosis was listed as spondyloarthritis (SpA) (54.3%), rheumatoid arthritis (RA) (25.7%), psoriatic arthritis (PsA) (8.4%), vasculitis (6.1%), and others (5.4%). Concurrent use of hydroxychloroquine (hazard ratio [HR] = 1.49), iv bDMARD use (HR = 1.34), and a history of discontinuation of drug in the first 3 months of the pandemic (HR = 1.19) were determined as factors that reduced 12-month drug retention rates. The use of glucocorticoid (HR = 3.81) and having a diagnosis of interstitial lung disease/chronic obstructive lung disease (HR = 4.96) were found to increase the risk of being infected by SARS coronavirus 2 (SARS-CoV-2). Conclusions: It was shown that approximately 1/5 of iRMD patients using b/tsDMARDs delayed their treatment due to the fear of COVID-19 in the first three months of the pandemic process. However, with good communication with the patients, b/tsDMARD treatment was restarted and the 12-month drug retention status was quite high.

Namık Kemal tıp dergisi, Mar 14, 2022

Aim: Modified Rodnan Skin Score (mRSS) is generally used to assess skin involvement in patients w... more Aim: Modified Rodnan Skin Score (mRSS) is generally used to assess skin involvement in patients with scleroderma. There are conflicting data on the effectiveness of mRSS training courses in previous studies. The aim of this study to evaluate the effectiveness of a mRSS training course applied to rheumatology minor residents. Materials and Methods: Ten rheumatology minor residents were included in the study. The participants were given a 1-hour theoretical training including skin involvement in scleroderma and mRSS evaluation, by three experienced rheumatology specialists. Then training continued with performing mRSS on 4 patients with scleroderma for 1 hour. Participants made scores on a paper form on 2 patients before and after the training, including 17 regions, and the total score was between 0 and 51. Inter-observer reliability for pre-and post-training was evaluated with intra-class correlation coefficient (ICC) analysis. Agreement was evaluated with Fleiss's kappa according to 12 different score regions before and after the training. Results: The ICC was detected as 0.867 [95% confidence interval (CI): 0.625-1.00, p=0.05] before the training, and 0.905 (95% CI: 0.045-1.00, p=0.02) after the training. When the regions of mRSS were evaluated individually, an increase in agreement was observed in some of the scores while there was no change in one region and a decrease in agreement was observed in some. Conclusion: This study has shown that mRSS is an effective scoring that can be easily conveyed with training courses.

PubMed, Jul 1, 2023

Objective: Subclinical macrovascular impairment, which has been evaluated with various arterial s... more Objective: Subclinical macrovascular impairment, which has been evaluated with various arterial stiffness (AS) parameters, has been defined in patients with systemic sclerosis (SSc). However, studies investigating the relationship between AS and clinical endpoints in SSc are lacking. This study aims to determine the prognostic value of AS parameters to predict all-cause mortality in SSc patients. Patients and methods: AS parameters [carotid-radial pulse wave velocity (PWV) and augmentation index (AIx)] were assessed via applanation tonometry. The prognostic value of these parameters was quantified in patients with SSc (n=60) without pulmonary arterial hypertension (PAH) and obvious cardiac involvement against survival. Results: The overall median follow-up time was 10.3 years, and a 29.4% (n=20) mortality was observed. Four significant predictors of mortality were observed: lung involvement (HR 2.608, p=0.04), the lower level of predicted carbon monoxide diffusing capacity (HR 0.978, p=0.03), lower level of estimated glomerular filtration rate (HR 0.979, p=0.04), and elevated serum C reactive protein (CRP) levels (HR 1.066, p<0.001). Among these variables, elevated CRP was found to be an independent predictor of all-cause mortality. AS parameters were not associated with all-cause mortality (HR 1.014, p=0.6 for AIx and HR 0.737, p=0.19 for PWV, respectively). Conclusions: Long-term data failed to demonstrate the prognostic value of AS parameters in predicting all-cause mortality in SSc patients. The exact mechanisms of cardiovascular (CV) mortality in SSc patients deemed to be atherosclerotic in origin needs to be determined in large-scale studies.

European Archives of Oto-rhino-laryngology, Nov 16, 2022

Background: Knee osteoarthritis is a chronic degenerative disease, known as the most common cause... more Background: Knee osteoarthritis is a chronic degenerative disease, known as the most common cause of difficulty walking in older adults and subsequently is associated with slow walking. Functional decline, increased risk of falls and presence of pain are, in many studies, related to the muscle weakness caused by osteoarthritis especially weakness of the quadriceps muscles. Pain is very noticeable while walking in rugged terrain, during ascent and descent of stairs, when changing from sitting to standing position as well as staying in one position for a long time. Many studies have shown that the strength of the quadriceps femoris muscle can affect gait, by improving or weakening it. Kinesio Tape is a physiotherapeutic technique, which reduces pain and increases muscular strength by irritating the skin receptors. Objectives: The aims of this study was firstly to verify if the application of Kinesio Tape on quadriceps femoris muscle decreases time needed to accomplish the 10 meter walk test in patients with knee osteoarthritis and also in subjects without knee osteoarthritis. Secondly if applying Kinesio Tape on quadriceps femoris muscle reduces pain while walking only in patients with knee osteoarthritis. Methods: In this study we observed the change of gait speed with the help of the 10-meter walk test before, one day and three days after the application of Kinesio Tape in quadriceps femoris muscle. We compared the results of the gait speed in two groups. In the first group, the Patients group, participated 102 outpatients with a clinical diagnosis of primary knee osteoarthritis, while in the second group, the Control group, participated 73 subjects with a main excluding criterion a clinical diagnosis of primary knee osteoarthritis. Secondly, we observed the change of pain, while walking for 10 meters at normal speed for the Patients group, before, one day and three days after the application, with the help of Numerical Pain Rating Scale-NRS.

and contribute to raising awareness of SS and to participate in patient and public involvement an... more and contribute to raising awareness of SS and to participate in patient and public involvement and engagement (PPIE) events. The majority of patients interviewed were willing to take part in research by donating blood samples and/or filling in questionnaires (96%). 58% of patients who completed the survey would either definitely or probably take part in discussion groups helping researchers to design future studies in SS. Conclusion: This survey highlighted patients' perception of the need for more meaningful research into the causes of SS, as their priorities were centred around finding a cure or better treatments for Sjögren's Syndrome. The survey also identified patients' lack of knowledge about their condition as well as their desire to help with shaping future research ideas and support funding for research. The results of this survey will be incorporated in our future PPIE events aiming at shaping our research strategy in SS.

Turkiye Klinikleri Journal of Internal Medical Sciences, 2007

Turkiye Klinikleri Journal of Rheumatology Special Topics, 2013

International Journal of Rheumatic Diseases, May 10, 2022

Rheumatology International, Jan 23, 2019

The introduction of tumor necrosis factor-alpha (TNF-α)-targeting drugs has given new opportuniti... more The introduction of tumor necrosis factor-alpha (TNF-α)-targeting drugs has given new opportunities in the treatment of various inflammatory rheumatic diseases and has been the most important development in the treatment of spondyloarthritis (SpA). However, the increasing use and longer follow-up periods of treatment also pose risks of developing various adverse effects ranging from common ones including infections to uncommon renal complications. This report describes a case of infliximab-induced focal segmental glomerulosclerosis (FSGS) in a 40-year-old female patient with ankylosing spondylitis (AS) who presented with asymptomatic proteinuria and microscopic hematuria. To the best of our knowledge, this is the second reported case of FSGS attributed to infliximab (IFX). A review of the English literature was conducted for cases of possible IFX-associated renal disorders in patients with SpA and SpA spectrum diseases. In this respect, the reported renal pathologies were IgA nephropathy, crescentic glomerulonephritis, acute renal artery occlusion, acute tubulointerstitial nephritis (ATIN), FSGS, and membranous glomerulopathy. Furthermore, partial or complete resolution was reported after cessation of therapy. In conclusion, although renal complications of TNF inhibitors (TNFi) are uncommon, spot urine evaluation may be recommended in the follow-up of patients treated with TNFi.

Rheumatology International, Sep 8, 2018

The aim of the study was to investigate the relationship of CPDAI with other follow-up parameters... more The aim of the study was to investigate the relationship of CPDAI with other follow-up parameters and to evaluate gender differences in measures in psoriatic arthritis (PsA) patients. This cross-sectional study included patients with PsA followed up at a rheumatology outpatient clinic. Disease activity was assessed using CPDAI, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Visual Analog Scale (VAS global) and Disease Activity Score (DAS28). Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels were measured. The Psoriasis Area and Severity Index (PASI) was used to measure of severity of psoriasis. Bath Ankylosing Spondylitis Functional (BASFI) and Metrology Indexes (BASMI), Health Assessment Questionnaire (HAQ), AS Quality of Life (ASQoL) and Dermatology Life Quality Index (DLQI) were evaluated. There were 117 patients with PsA (78 female) who fulfilled the Classification Criteria for Psoriatic Arthritis. Their mean CPDAI score was 3.67 (± 2.46). The CPDAI was positively correlated with tender/swollen joint counts, dactylitis and enthesitis. There was strong positive correlation between CPDAI and BASDAI, DAS28 and VAS global , but no correlation found between the CPDAI and ESR, CRP and BASMI. Mean CPDAI scores were similar in females and males. Female patients were found to have worse subjective scores including BASDAI, VAS global , BASFI, HAQ and ASQoL than males (p < 0.05). However, objective disease parameters such as ESR, CRP, tender/swollen joint counts, DAS28 and BASMI were similar in both gender groups. This study confirmed that CPDAI, a compound scale to assess disease activity in PsA, was well correlated with other disease activity measurements. Although subjective disease scores were higher in female patients, CPDAI was not affected by gender.

Clinical and Experimental Rheumatology

Objective Digital ulcers (DUs) are associated with a significant burden in systemic sclerosis (SS... more Objective Digital ulcers (DUs) are associated with a significant burden in systemic sclerosis (SSc) by leading to severe pain, physical disability, and reduced quality of life. This effort aimed to develop recommendations of the Turkish Society for Rheumatology (TRD) on the management of DUs associated with SSc. Methods In the first meeting held in December 2020 with the participation of a task force consisting of 23 rheumatologists the scope of the recommendations and research questions were determined. A systematic literature review was conducted by 5 fellows and results were presented to the task force during the second meeting. The Oxford system was used to determine the level of evidence. The preliminary recommendations were discussed, modified, and voted by the task force and then by members of TRD via e-mail invitation allowing personalised access to a web-based questionnaire [SurveyMonkey®]. Results A total of 23 recommendations under 7 main headings were formulated covering non-pharmacological measures for the prevention of DUs and pharmacological treatments including vasodilators, anti-aggregants, antibiotics, wound care, pain control, and interventions including sympathectomy, botulinum toxin, and surgery. Risk factors, poor prognostic factors, prevention of DU and adverse effects of medical treatments were reported as 4 overarching principles. Conclusion These evidence-based recommendations for the management of SSc-associated DUs were developed to provide a useful guide to all physicians who are involved in the care of patients with SSc, as well as to point out unmet needs in this field.

Journal of Contemporary Medicine

Objective: To determine the high levels of acute phase reactants (APR) of ankylosing spondylitis ... more Objective: To determine the high levels of acute phase reactants (APR) of ankylosing spondylitis (AS) patients at diagnosis and follow-up, and to investigate the relationship between patients’ high levels of APR and patients’ disease activity levels and clinical characteristics. Material and Methods : 948 patients who were diagnosed with AS according to the modified 1984 New York criteria and followed-up at the university rheumatology clinic were included in this study. The patients’ erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels across all visits were retrospectively reviewed through the registry and the hospital’s database. Results: At first visit, high levels of CRP and ESR were observed in 626 (68.5%) and 578 (64.6%) patients respectively. During follow-up 84.6% of patients had high CRP and 69.5% patients had high ESR, however in 10% of patients APRs did not increase at all. There was good correlation between ESR and CRP (r=0.666, p=0.000). A better cor...