The cost of care of rheumatoid arthritis and ankylosing spondylitis patients in tertiary care rheumatology units in Turkey.

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. CONCLUSIONS: 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.

Autoantibody profile in systemic sclerosis as a marker for esophageal and other organ involvement in Turkish populations.

Systemic sclerosis (SSc) is a connective tissue disorder of unknown etiology characterized by fibrosis and vascular obliteration in the skin, gastrointestinal tract, lungs, and heart. Our aim was to investigate the autoantibody profile in patients with esophageal involvement of SSc and to describe the relationship between the autoantibody profile and organ involvement in SSc. We studied 47 SSc patients, all with esophageal involvement shown on esophageal manometry. The patients were separated into three groups based on the absence or presence of ANA, Scl70, and ACA. In this study ANA and Scl70 were present more frequently than ACA in patients with esophageal involvement of SSc. Pulmonary involvement and heart involvement were seen more in Scl70-positive and ACA-positive patients, respectively. We conclude that in patients with SSc, closer follow-up with autoantibody profile may enable early diagnosis of specific organ involvement and treatment of debilitating symptoms, with avoidance of potential life-threatening complications.

Von Willebrand factor antigen levels in Behçet disease.

High von Willebrand factor antigen (vWF:Ag) levels can be found due to vascular endothelial injury in Behçet disease. The aim of this study is to evaluate whether there is any relationship between vWF:Ag levels and vascular or other organ involvements and acute-phase reactants in Behçet disease. Fifteen controls and 17 Behçet's patients were included; 10 had oral ulcers, 5 had genital ulcers, 3 had skin lesions, 6 had ocular involvement, 5 had arthritis, and 6 had vascular involvement. VWF:Ag levels were higher in Behçet's patients than controls. VWF:Ag levels in Behçet's patients with oral ulcers, genital ulcers, and ocular and vascular involvement were statistically higher than in the control group. Differences between vWF:Ag levels in Behçet's patients with and without organ involvement were not statistically significant. A linear correlation between serum ferritin levels and vWF:Ag levels was observed. These results demonstrate that elevated levels of plasma vWF:Ag are related to Behçet disease exacerbation rather than vascular involvement.