Person: DİRESKENELİ, RAFİ HANER
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DİRESKENELİ
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RAFİ HANER
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Publication Metadata only Femoral vein wall thickness measurement: A new diagnostic tool for Behcet's disease(OXFORD UNIV PRESS, 2021) ALİBAZ ÖNER, FATMA; Alibaz-Oner, Fatma; Ergelen, Rabia; Yildiz, Yasin; Aldag, Mustafa; Yazici, Ayten; Cefle, Ayse; Koc, Ertan; Esen, Bahar Artim; Mumcu, Gonca; Ergun, Tulin; Direskeneli, HanerObjectives. Diagnosing Behcet's disease (BD) is a challenge, especially in countries with a low prevalence. Recently, venous wall thickness (VWT) in lower extremities has been shown to be increased in BD patients. In this study, we aimed to investigate the diagnostic performance of common femoral vein (CFV) thickness measurement in BD and whether it can be used as a diagnostic tool. Methods.. Patients with BD (n=152), ankylosing spondylitis (n=27), systemic vasculitides (n=23), venous insufficiency (n=29), antiphospholipid syndrome (APS; n=43), deep vein thrombosis due to non-inflammatory causes (n=25) and healthy controls (n=51) were included in the study. Bilateral CFV thickness was measured with ultrasonography by a radiologist blinded to cases. Results. Bilateral CFV thickness was significantly increased in BD compared with all control groups (P < 0.001 for all). The area under the receiver operating characteristic curve for bilateral CFV thicknesses in all comparator groups was >0.95 for the cut-off value (0.5 mm). This cut-off value also performed well against all control groups with sensitivity rates >90%. The specificity rate was also >80% in all comparator groups except APS (positive predictive value: 79.2-76.5%, negative predictive value: 92-91.8% for right and left CFV, respectively). Conclusion. Increased CFV thickness is a distinctive feature of BD and is rarely present in healthy and diseased controls, except APS. Our results suggest that CFV thickness measurement with ultrasonography, a non-invasive radiological modality, can be a diagnostic tool for BD with sensitivity and the specificity rates higher than 80% for the cut-off value >= 0.5mm.Publication Metadata only Could Sublingual Immunotherapy Affect Oral Health in Children with Asthma and/or Allergic Rhinitis Sensitized to House Dust Mite?(KARGER, 2017) ÖZEN, AHMET OĞUZHAN; Kiykim, Ayca; Mumcu, Gonca; Ogulur, Ismail; Karakoc-Aydiner, Elif; Direskeneli, Haner; Baris, Safa; Cagan, Hasret; Ozen, AhmetBackground: Sublingual immunotherapy (SLIT) has been successfully employed in IgE-mediated respiratory allergies. However, it is not known whether the modulation of immune responses in the sublingual area during SLIT has any deleterious effect on oral health. We sought to determine the oral health prospectively in children receiving SLIT for house dust mite allergy. Material and Methods: Eighteen children with allergic asthma and/or rhinitis and 31 agematched healthy controls (HC) were included in an openlabeled trial. Oral health was evaluated by scoring the decayed, missing, and filled teeth for primary (dmft) and permanent (DMFT) dentition, and the plaque and gingival indices. Moreover, cariogenic food intake and teeth-brushing habits were also noted at baseline and at 19 months. Results: The mean age of the SLIT participants was 9.5 +/- 3.1 years and that of the HC was 9.2 +/- 3.7 years. The mean duration of SLIT was 19.13 +/- 3.81 months. At baseline, the total dmft and DMFT indices were similar in the SLIT and HC groups (p > 0.05), which demonstrated poor hygiene overall. In the within-group comparisons at the examination at 19 months, the SLIT group had a lower number of carious primary teeth and a higher number of filled primary teeth compared to the count at baseline (p = 0.027 and p = 0.058, respectively). Conclusion: Our study showed no detrimental effect of SLIT on oral health during a period of 19 months of follow-up. Parents should be motivated to use dental health services to prevent new caries formation since our cohort had overall poor oral hygiene at the baseline. (C) 2017 S. Karger AG, BaselPublication Open Access Pro-inflammatory cytokine and caspase-1 responses to pattern recognition receptor activation of neutrophils and dendritic cells in Behcet's disease(OXFORD UNIV PRESS, 2013-05-01) MUMCU, GONCA; Ture-Ozdemir, Filiz; Tulunay, Aysin; Elbasi, Mehmet Onur; Tatli, Imren; Maurer, Anne-Marie; Mumcu, Gonca; Direskeneli, Haner; Eksioglu-Demiralp, EmelObjective. Activated innate immunity is implicated in the pathogenesis of Behcet's disease (BD). To clarify the mechanisms of innate immune responses, we investigated inflammasome activation in dendritic cells (DCs) and neutrophils, following stimulation with two different pattern recognition receptors (PRRs) RIG-1-like (RLR) and NOD-like (NLR) in patients with BD. Methods. Sixteen active BD patients with mucocutaneous lesions and 17 healthy controls (HCs) were included in this study. DCs were generated from monocytes. DCs and isolated neutrophils were activated by RLR and NLR ligands. Caspase-1 activation and expression of p38 and RIP2 were determined by flow cytometry. Levels of IL-1 beta, IL-6, TNF-alpha, IFN-alpha and IL-18 in culture supernatants were measured by ELISA. Results. Activation of caspase-1 following intracellular PRR stimulation was found to be of similar levels in DCs and neutrophils of BD patients compared with HCs. However, activation of DCs from BD patients to NOD2 stimulus measured by the expression of RIP2 and p38 as well as IL-18 levels was found to be slightly defective (P < 0.05). In neutrophil cultures, IL-6 levels were lower in response to all stimuli in patients with BD compared with HCs (P < 0.01). Conclusion. Inflammasome formation following stimulation with NOD1/NOD2 and RIG measured by caspase-1 activation, cytokine levels and expression of RIP2 and p38 seems to be functionally normal in DCs and neutrophils of BD patients, although slightly defective responses in some pathways and cytokine levels were observed. These results may suggest that caspase-1-independent pathways such as toll-like receptors may be more prominent in BD pathogenesis.Publication Metadata only Oral health is a mediator for disease severity in patients with Behcet's disease: A multiple mediation analysis study(WILEY, 2019) AKSOY, AYSUN; Yay, Meral; Celik, Zulal; Aksoy, Aysun; Alibaz-Oner, Fatma; Inanc, Nevsun; Ergun, Tulin; Direskeneli, Haner; Mumcu, GoncaObjectivesThe aim of the study was to examine whether oral health as an infection focus could mediate disease course in patients with Behcet's disease (BD). MethodsIn the study, oral health of 194 BD patients was examined at baseline and follow-up periods. The reasons for last dental visits were recorded as tooth extraction or regular control visits/planned treatments at the end of follow-up period. The Behcet's disease severity score was calculated with higher scores indicating a more severe course. Mediation analysis was carried out to assess the effects of oral health on disease severity score at follow-up period in the study. ResultsDental and periodontal indices were found to be higher at follow-up visit compared to those of baseline (P<0.05). Disease severity score was found to be higher in males (5.32.4) compared to females (4.4 +/- 2.5) in the whole group (P=0.005). Moreover, patients having tooth extraction at their last dental visit and patients with dental caries had a more severe disease course (5.4 +/- 2.4; 5.5 +/- 2.5) compared to others (4.2 +/- 2.3; 4.4 +/- 2.4; P<0.0001). In multiple mediation analysis, disease severity score was a dependent variable and was directly mediated by male gender (B=-0.8822, P=0.0145) and indirectly mediated through the presence of dental caries (B=0.9509 P=0.0110) and need of tooth extraction (B=0.8758, P=0.0128). ConclusionBoth presence of dental caries and need of tooth extraction were observed to be effective mediators for a more severe disease course in BD. Therefore, better oral health should be aimed to eliminate microbial factors, which are a part of pathogenic processes.Publication Open Access A MODERATED MEDIATION ANALYSIS FOR POOR ORAL HEALTH-RELATED QUALITY OF LIFE IN PATIENTS WITH BEHCET'S DISEASE(BMJ PUBLISHING GROUP, 2021-06) ALİBAZ ÖNER, FATMA; Cakir, E. N.; Yenisoy, Y.; Kapusuz, A.; Abacar, K.; Alibaz-Oner, F.; Yay, M.; Karacayli, U.; Inanc, N.; Ergun, T.; Direskeneli, H.; Mumcu, G.Publication Open Access Presence of Fibromyalgia in Patients with Takayasu's Arteritis(JAPAN SOC INTERNAL MEDICINE, 2013) ALİBAZ ÖNER, FATMA; Alibaz-Oner, Fatma; Can, Meryem; Ilhan, Birkan; Polat, Ozge; Mumcu, Gonca; Direskeneli, HanerObjective Data regarding the frequency of fibromyalgia (FM) in patients with Takayasu's arteritis (TAK) have not been previously reported. We aimed to investigate the frequency of FM in TAK, defined according to the new 2010 ACR Preliminary Diagnostic Criteria for Fibromyalgia. The association between the ACR-1990 and 2010 FM criteria and the effects of patient-reported outcomes (PROs) on FM were also analyzed. Methods We studied 55 patients (age: 42,30 +/- 12,37 years, F/M: 49/6) with TAK and 40 age-and sex-matched controls (age: 41 +/- 10.84 years, F/M: 31/9). All patients were examined for FM tender points by two observers and asked to complete the ACR 2010 FM questionnaire for FM. The SF-36, the Health Assessment Questionnaire (HAQ) and hospital anxiety and depression scales (HADS) were used to assess the quality of life. Thirty patients were reevaluated six months later. Results Seven (12.7%) patients with TAK and four patients with HC (10%) fulfilled the 2010 FM criteria (p=0.682), while three (5.4%) TAK patients and no controls (0%) met the 1990 criteria (p=0.133). FM was found at a significantly higher rate in the active patients than in the inactive patients according to the ACR-2010 FM criteria (p=0.006). The SF-36 physical component scores were significantly lower (p=0.003) and the HAQ scores were significantly higher in the TAK (p=0.006) patients than in the controls. Conclusion The frequency of FM is similar between the general population and patients with TAK. However, the incidence of FM is significantly higher in active patients. The new FM criteria subscales (WPI, SSS) are significantly correlated with scales such as the SF-36, anxiety and depression scales and HAQ in TAK patients, suggesting that, in a minority of patients with FM and TAK, PROs may be affected by the presence of FM.Publication Metadata only Salivary levels of antimicrobial peptides Hnp 1-3, Ll-37 and S100 in Behcet's disease(PERGAMON-ELSEVIER SCIENCE LTD, 2012) MUMCU, GONCA; Mumcu, Gonca; Cimilli, Hale; Karacayli, Umit; Inanc, Nevsun; Ture-Ozdemir, Filiz; Eksioglu-Demiralp, Emel; Ergun, Tulin; Direskeneli, HanerBackground: Oral ulcer is the cardinal clinical sign and increased neutrophilic activity is a part of the pathogenesis in Behcet's disease (BD). Saliva, as a part of the innate immune response, contains antimicrobial peptides (AMPs) that are derived from both oral epithelial cells and neutrophils. The aim of this study was to investigate the associations between salivary levels of AMPs HNP 1-3, LL-37 and S100 and disease course in patients with Behcet's disease (BD). Methods: Fifty-three patients with BD and 44 healthy controls (HC) were included in the study. Disease severity score reflecting organ involvement was calculated. Salivary HNP 1-3, LL-37 and S100 levels were measured in unstimulated saliva samples by ELISA. Results: Salivary HNP 1-3 and S100 levels in BD patients (2715.2 +/- 1333.4 mu g/ml and 430.6 +/- 203.9 mu g/ml) were significantly higher compared to HC (1780.6 +/- 933.2 mu g/ml and 365.3 +/- 84.7 mu g/ml) (p = 0.000 and p = 0.004, respectively). Although LL-37 levels were also higher in BD than HC (190.9 +/- 189.1 vs 143.1 +/- 128.9 ng/ml), no significant difference was observed (p = 0.53). Salivary HNP 1-3 and LL-37 levels were associated with the severity of BD (mild disease: 1975.1 +/- 1174.2 mu g/ml and 115.9 +/- 109.4 ng/ml vs severe disease: 2955.7 +/- 1305.6 mu g/ml and 215.3 +/- 203.8 ng/ml, p = 0.020 and p = 0.031, respectively). Salivary LL-37 levels also correlated with the number of monthly oral ulcers (r = 0.5 p = 0.000). Conclusion: An increase in salivary HNP 1-3 and S100 levels might be associated with enhanced local and systemic innate responses in BD. (C) 2011 Elsevier Ltd. All rights reserved.Publication Open Access The OMERACT Core Set of Domains for Outcome Measures in Behçet Syndrome(2020) MUMCU, GONCA; Hatemi, Gülen; Meara, Alexa; Ozguler, Yesim; Direskeneli, Haner; Mahr, Alfred; Shea, Beverly; Cam, Esen; Gul, Ahmet; Yazici, Yusuf; Tugwell, Peter; Yazici, Hasan; Merkel, Peter A.; OMERACT Behçet Syndrome Working GroupOBJECTIVE: There is an unmet need for reliable, validated, and widely-accepted outcome measures for randomized clinical trials in Behçet syndrome (BS). The Outcome Measures in Rheumatology Clinical Trials (OMERACT) BS Working Group, a large, multi-disciplinary group of experts in BS and patients with BS, worked to develop a Core Set of data-driven outcome measures for use in all clinical trials of BS. METHODS: The Core Domain Set was developed through a comprehensive, iterative, multi-stage project which included a systematic review, a focus group meeting and qualitative patient interviews, a survey among experts in BS, a Delphi exercise involving both patients and physician-experts in BS, and utilization of the data, insight, and feedback generated by these processes to develop a final Core Domain Set. RESULTS: All steps were completed and domains were delineated across the organ systems involved in this disease. Since trials in BS often focus on specific manifestations and not the disease in its entirety, the final proposed Core Set includes 5 domains mandatory for study in all trials in BS (disease activity, new organ involvement, quality of life, adverse events, and death) with additional sub-domains mandatory for study of specific organ-systems. The final Core Set was endorsed at the 2018 OMERACT meeting. CONCLUSION: The Core Set of Domains in BS provides the foundation through which the international research community, including clinical investigators, patients, biopharmaceutical industry, and government regulatory bodies can harmonize the study of this complex disease, compare findings across studies, and advance development of effective therapies.Publication Metadata only The Assessment of Presenteeism and Activity Impairment in Behcet's Syndrome and Recurrent Aphthous Stomatitis: A multicentre Study(2021) ALİBAZ ÖNER, FATMA; Karacayli, Umit; Adesanya, Adebowale; Aksoy, Aysun; Belem, Joice M. F. M.; Cardin, Natália Borges; Sarı, Fatma Busra; Beyhan, Tuğba Emine; Çelik, Zülal; Karacayli, Ceren; Alibaz-Öner, Fatma; Inanç, Nevsun; Ergun, Tülin; Yay, Meral; Madanat, Wafa; Silva de Souza, Alexandre Wagner; Fortune, Farida; Direskeneli, Haner; Mumcu, GoncaOBJECTIVE: To evaluate key factors for Presenteeism and Activity impairment in multinational patients with Behçet's syndrome (BS) and recurrent aphthous stomatitis (RAS). METHODS: In this cross-sectional study, 364 BS patients from Jordan, Brazil, the United Kingdom and Turkey and 143 RAS patients from the United Kingdom and Turkey were included. Work Productivity Activity Impairment (WPAI) scale was used for Presenteeism and Activity impairment. Mediation analyses were performed to evaluate both direct and indirect causal effects. RESULTS: Presenteeism score was higher in active patients with genital ulcers and eye involvement as well as patients with comorbidities and current smokers than the others in BS (p< 0.05). In RAS, Presenteeism score was elevated by oral ulcer activity in the direct path (p= 0.0073) and long disease duration as a mediator in the indirect path (p= 0.0191).Patients with active joint involvement had poor scores in Absenteeism, Presenteeism, Overall impairment and Activity impairment compared with those of inactive patients (p < 0.05). Using mediation analysis, the Activity impairment score was directly mediated by joint activity (p = 0.0001) and indirectly mediated through oral ulcer-related pain in BS (p = 0.0309). CONCLUSION: In BS, Presenteeism was associated with disease activity, presence of comorbidities and being a current smoker, whereas in RAS, Presenteeism was associated with oral ulcer activity and increased length of the disease. Moreover, Activity impairment was adversely affected by joint activity and oral ulcer related pain in BS. Patients need to be empowered by using appropriate treatment strategies in their working environment and daily life.Publication Open Access Oral ulcer activity in Behcet's disease: Poor medication adherence is an underestimated risk factor(AVES, 2017-06-12) ALİBAZ ÖNER, FATMA; Mumcu, Gonca; Alibaz-Oner, Fatma; Oner, Sibel Yilmaz; Ozen, Gulsen; Atagunduz, Pamir; Inanc, Nevsun; Koksal, Leyla; Ergun, Tulin; Direskeneli, HanerObjective: The aim of this study was to evaluate the relationship between oral ulcer activity and medication adherence according to gender in Behcet's disease (BD) patients. Material and Methods: The study group included 330 BD patients (F/M: 167/163, mean age: 38.5 +/- 10.5 years). Oral ulcer activity and medication adherence were evaluated in the previous month. Medication adherence was evaluated using the 8-item Morisky Medication Adherence Scale (MMAS-8) having a score range of 0 to 8 with high scores indicating better adherence. Low adherence was defined as < 6 points on MMAS-8. Results: Over half of the group had active oral ulcers (n= 219, 66.4%) within the month preceding the visit. The number of oral ulcers was significantly higher in female patients with low medication adherence (2.39 +/- 3.24) than in the rest of the female group (1.28 +/- 2.05; p= 0.023). Although a similar trend was also observed in male patients (2.14 +/- 3.3 vs. 1.81 +/- 2.31), a significant relationship was not observed (p= 0.89). The frequency of medication intake per day was lower in patients with high medication adherence than in the rest of the study group (p= 0.04). Conclusion: Low medication adherence is a hidden risk factor in the management of BD. Poor adherence was associated with oral ulcer activity in female BD patients.