Person: DİRESKENELİ, RAFİ HANER
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DİRESKENELİ
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RAFİ HANER
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Publication Metadata only Assessment of latent tuberculosis infection in Takayasu arteritis with tuberculin skin test and Quantiferon-TB Gold test(SPRINGER HEIDELBERG, 2010) DİRESKENELİ, RAFİ HANER; Karadag, Omer; Aksu, Kenan; Sahin, Abdurrahman; Zihni, Figen Yargucu; Sener, Burcin; Inanc, Nevsun; Kalyoncu, Umut; Aydin, Sibel Zehra; Ascioglu, Sibel; Ocakci, Pinar Talu; Bilgen, Sule Apras; Keser, Gokhan; Inal, Vedat; Direskeneli, Haner; Calguneri, Meral; Ertenli, Ihsan; Kiraz, SedatA possible relationship between Takayasu arteritis (TA) and tuberculosis (TB) has been suggested. An increased frequency of tuberculin skin test (TST) was observed in TA patients. Quantiferon-TB Gold test (QFT) is a new in vitro assay measuring interferon-gamma response to M. tuberculosis antigens and helpful in diagnosing latent TB infection. The aim of this study was to investigate latent TB infection among TA patients by the use of both TST and QFT Gold test. Ninety-four (male/female: 7/87) TA patients fulfilling ACR 1990 TA criteria from three different university hospitals in Turkey and 107 control subjects without inflammatory diseases were included in the study. Data about medical history (TA and TB) were collected for both groups. TST and QFT were performed. TST values a parts per thousand yen5 mm for TA patients and a parts per thousand yen15 mm for controls was accepted as TST positivity. Even though TA group was older (40 +/- A 12 vs. 32 +/- A 8, P < 0.001), there was no significant difference between TA patients and controls regarding demographic characteristics. Six TA patients and one control had a history of previous TB infection (P = 0.054). Although TST positivity was higher in TA group [55 patients (62.5%) vs. 24 controls (41.4%), P = 0.008], QFT positivity was similar between two groups [21 patients (22.3%) vs. 24 controls (22.4%), P > 0.05]. QFT was negative in two of six TA patients with previous TB history. Rate of latent TB infection in TA patients measured with QFT is no more than controls. QFT seems to be a good and favorable test compared with TST in detecting LTBI in TA.Publication Metadata only Anti-CCP antibodies in rheumatoid arthritis and psoriatic arthritis(SPRINGER LONDON LTD, 2007) DİRESKENELİ, RAFİ HANER; Inanc, N.; Dalkilic, E.; Kamali, S.; Kasapoglu-Gunal, E.; Elbir, Y.; Direskeneli, H.; Inanc, M.Our aim is to assess the prevalence and associated clinical features of anti-CCP (cyclic citrullinated peptide) antibodies for RF (rheumatoid factor)-positive and RF-negative rheumatoid arthritis (RA) and psoriatic arthritis (PsA). In a prospective, cross-sectional, multi-centre study, we determined the titres of anti-CCP antibodies in 208 RA patients (129 RF-positive, 79 RF-negative), 56 PsA patients and 39 healthy controls (HC). Clinical parameters including disease activity (disease activity score 28-DAS28), physical disability (health assessment questionnaire-HAQ), functional capacity (functional class) and radiological erosions were investigated in patients with RA. In PsA patients, clinical and radiological features were determined. Anti-CCP2 antibodies were measured using a second-generation anti-CCP enzyme-linked immunosorbent assay (Euro-Diagnostica, Netherlands). One-hundred four of 129 RF-positive RA (81%), 16 of 79 RF-negative RA (20%), seven of 56 PsA patients (12.5%) and none of the HC had anti-CCP antibodies. RA patients with anti-CCP antibodies had significantly higher disease activity, greater loss of function and more frequent erosive disease than anti-CCP antibody-negative group. In subgroup analysis, anti-CCP antibodies in RF-negative patients were also associated with erosive disease. All PsA patients with anti-CCP antibodies had symmetric arthritis with higher number of swollen joints. The prevalence of anti-CCP antibodies in RF-positive RA patients was significantly higher than in RF-negative RA and PsA patients. Anti-CCP antibodies were also associated with erosive disease in RF-negative RA patients. Both anti-CCP and RF tests were negative in 30% of the patients. Anti-CCP positivity was a frequent finding in PsA and associated with symmetrical polyarthritis.Publication Metadata only Secukinumab and infectious adverse effects: A real-life experience of 63 psoriasis patients(2021) SEÇKİN GENÇOSMANOĞLU, DİLEK; Ergun, Tulin; Seckin, Dilek; Demir, Gizem; Direskeneli, HanerPublication 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 The distribution of MEFV mutations in Turkish FMF patients: multicenter study representing results of Anatolia(TUBITAK SCIENTIFIC & TECHNICAL RESEARCH COUNCIL TURKEY, 2019) DİRESKENELİ, RAFİ HANER; Yasar Bilge, N. Sule; Sari, Ismail; Solmaz, Dilek; Senel, Soner; Emmungil, Hakan; Kilic, Levent; Yilmaz Oner, Sibel; Yildiz, Fatih; Yilmaz, Sedat; Ersozlu Bozkirli, Duygu; Aydin Tufan, Muge; Yilmaz, Sema; Yazisiz, Veil; Pehlivan, Yavuz; Bes, Cemal; Yildirim Cetin, Gozde; Erten, Sukran; Gonullu, Emel; Sahin, Fezan; Akar, Servet; Aksu, Kenan; Kalyoncu, Umut; Direskeneli, Haner; Erken, Eren; Kisacik, Bunyamin; Sayarlioglu, Mehmet; Cinar, Muhammed; Kasifoglu, TimucinBackground/aim: The distribution of Mediterranean fever (MEFV) gene mutations in Turkish familial Mediterranean fever (FMF) patients varies according to geographic area of Turkey. There is a need for highly representative data for Turkish FMF patients. The aim of our study was to investigate the distribution of the common MEFV mutations in Turkish FMF patients in a nationwide, multicenter study. Materials and methods: Data of the 2246 FMF patients, from 15 adult rheumatology clinics located in different parts of the country, were evaluated retrospectively. The following mutations have been tested in all patients: M694V, M680I, M694I, V726A, and E148Q. Results: There were 1719 FMF patients with available genetic testing. According to the genotyping, homozygous M694V, present in 413 patients (24%), was the most common mutation . One hundred and fifty-four (9%) of patients had no detectable mutations. Allele frequencies of common mutations were: M694V (n = 1529, 44.5%), M680I (n = 423, 12.3%), V726A (n = 315, 9.2%), E148Q (n = 214, 1%), and M694I (n = 12, <1%). Conclusion: In this large-scale multicenter study, we provided information about the frequencies of common MEFV gene mutations obtained from adult Turkish IMF patients. Nearly half of the patients were carrying at least one M694V mutations in their alleles.Publication Metadata only Biomarkers in Remission According to Different Criteria in Patients with Rheumatoid Arthritis(J RHEUMATOL PUBL CO, 2015) DİRESKENELİ, RAFİ HANER; Yilmaz-Oner, Sibel; Ozen, Gulsen; Can, Meryem; Atagunduz, Pamir; Direskeneli, Haner; Inanc, NevsunObjective. Remission is the primary aim in the treatment of patients with rheumatoid arthritis (RA). In this study, we aimed to evaluate biomarker profiles of patients in remission by different criteria and compare these profiles with controls. Methods. Serum levels of calprotectin, interleukin 6 (IL-6), type II collagen helical peptide, C-terminal crosslinking telopeptide of type I collagen generated by matrix metalloproteinases (ICTP), matrix metalloproteinase 3 (MMP-3), resistin, and leptin were measured by ELISA in 80 patients. The patients were in Disease Activity Score at 28 joints with erythrocyte sedimentation rate (DAS28-ESR) remission, and had these characteristics: female/male 54/26, mean age 51.4 +/- 12.1 years, mean disease duration 11.4 +/- 8.1 years, rheumatoid factor positivity 68.7% (n = 55), anticyclic citrullinated peptide positivity 60.7% (n = 48). These patients were also evaluated for the American College of Rheumatology/European League Against Rheumatism (Boolean) and Simple Disease Activity Index (SDAI) remissions. Additionally, 80 age-, sex-, and comorbidity-matched individuals without rheumatic diseases were included in the study as controls. Results. At recruitment of 80 patients in DAS28 remission, 33 patients (41.2%) were found in Boolean remission and 39 patients (48.7%) were in SDAI remission. Serum MMP-3, ICTP, resistin, and IL-6 levels of the 80 patients in DAS28 remission were statistically significantly higher than the controls. Patients in Boolean and SDAI remissions had significantly higher serum ICTP, resistin, and IL-6 levels in comparison with the controls. Conclusion. The 3 commonly used remission criteria of RA are almost similar with regard to patients' biomarker levels. Biomarker profiles of patients may provide complementary information to clinical evaluation of remission and may help to determine the patients under the risk of progression.Publication Metadata only Association of venous thromboembolic events with skin, pulmonary and kidney involvement in ANCA-associated vasculitis: a multinational study(OXFORD UNIV PRESS, 2021) DİRESKENELİ, RAFİ HANER; Moiseev, Sergey; Kronbichler, Andreas; Makarov, Egor; Bulanov, Nikolay; Crnogorac, Matija; Direskeneli, Haner; Galesic, Kresimir; Gazel, Ummugulsum; Geetha, Duvuru; Guillevin, Loic; Hruskova, Zdenka; Little, Mark A.; Ahmed, Adeel; McAdoo, Stephen P.; Mohammad, Aladdin J.; Moran, Sarah; Novikov, Pavel; Pusey, Charles D.; Rahmattulla, Chinar; Satrapova, Veronika; Silva, Joana; Terrier, Benjamin; Tesar, Vladimir; Westman, Kerstin; Jayne, David R. W.Objective. To investigate the occurrence of venous thromboembolic events (VTE) in a large cohort of patients with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) across the European Union, Turkey, Russia, UK and North America. Methods. Patients with a definite diagnosis of AAV who were followed for at least 3months and had sufficient documentation were included. Data on VTE, including either deep vein thrombosis or pulmonary embolism, were collected retrospectively from tertiary vasculitis centres. Univariate and multivariate regression models were used to estimate odds ratios (ORs) and 95% CIs. Results. Over a median follow-up of 63 (interquartile range: 29, 101) months, VTE occurred in 278 (9.7%) of 2869 AAV patients with a similar frequency across different countries (from 6.3% to 13.7%), and AAV subtype [granulomatosis with polyangiitis: 9.8% (95% CI: 8.3, 11.6%); microscopic polyangiitis: 9.6% (95% CI: 7.9, 11.4%); and eosinophilic granulomatosis with polyangiitis: 9.8% (95% CI: 7.0, 13.3%)]. Most VTE (65.6%) were reported in the first-year post-diagnosis. Multiple factor logistic regression analysis adjusted for sex and age showed that skin (OR 1.71, 95% CI: 1.01, 2.92), pulmonary (OR 1.78, 95% CI: 1.04, 3.14) and kidney [eGFR 15-60ml/min/1.73 m(2), OR 2.86 (95% CI: 1.27, 6.47); eGFR <15ml/min/1.73 m(2), OR 6.71 (95% CI: 2.94, 15.33)] involvement were independent variables associated with a higher occurrence of VTE. Conclusion. Two-thirds of VTE occurred during the initial phase of active disease. We confirmed previous findings from smaller studies that a decrease in kidney function, skin involvement and pulmonary disease are independently associated with VTE.Publication Metadata only Characteristics Predicting Tuberculosis Risk under Tumor Necrosis Factor-alpha Inhibitors: Report from a Large Multicenter Cohort with High Background Prevalence(J RHEUMATOL PUBL CO, 2016) DİRESKENELİ, RAFİ HANER; Kisacik, Bunyamin; Pamuk, Omer Nuri; Onat, Ahmet Mesut; Erer, Sait Burak; Hatemi, Gulen; Ozguler, Yesim; Pehlivan, Yavuz; Kilic, Levent; Ertenli, Ihsan; Can, Meryem; Direskeneli, Haner; Keser, Gokhan; Oksel, Fahrettin; Dalkilic, Ediz; Yilmaz, Sedat; Pay, Salih; Balkarli, Ayse; Cobankara, Veli; Cetin, Gode Yildirim; Sayarlioglu, Mehmet; Cefle, Ayse; Yazici, Ayten; Avci, Ali Berkant; Terzioglu, Ender; Ozbek, Suleyman; Akar, Servet; Gul, AhmetObjective. Screening strategies for latent tuberculosis (TB) before starting tumor necrosis factor (TNF)-alpha inhibitors have decreased the prevalence of TB among patients who are treated with these agents. However, despite vigilant screening, TB continues to be an important problem, especially in parts of the world with a high background TB prevalence. The aim of this study was to determine the factors related to TB among a large multicenter cohort of patients who were treated with anti-TNF. Methods. Fifteen rheumatology centers participated in this study. Among the 10,434 patients who were treated with anti-TNF between September 2002 and September 2012, 73 (0.69%) had developed TB. We described the demographic features and disease characteristics of these 73 patients and compared them to 7695 patients who were treated with anti-TNF, did not develop TB, and had complete data available. Results. Among the 73 patients diagnosed with TB (39 men, 34 women, mean age 43.6 +/- 13 yrs), the most frequent diagnoses were ankylosing spondylitis (n = 38) and rheumatoid arthritis (n = 25). More than half of the patients had extrapulmonary TB (39/73, 53%). Six patients died (8.2%). In the logistic regression model, types of anti-TNF drugs [infliximab (IFX), OR 3.4, 95% CI 1.88-6.10, p = 0.001] and insufficient and irregular isoniazid use (<9 mos; OR 3.15, 95% CI 1.43-6.9, p = 0.004) were independent predictors of TB development. Conclusion. Our results suggest that TB is an important complication of anti-TNF therapies in Turkey. TB chemoprophylaxis less than 9 months and the use of IFX therapy were independent risk factors for TB development.Publication Metadata only Kronik aerobik egzersizin takayasu arteritinde kardiyopulmoner sağlamlık ve vasküler fonksiyon üzerine olası koruyucu etkilerinin araştırılması(2022-05-12) ALİBAZ ÖNER, FATMA; DİRESKENELİ, RAFİ HANER; KASIMAY ÇAKIR, ÖZGÜR; Harman Yerli N., Abacar K., Alibaz Öner F., Direskeneli R. H., Kasımay Çakır Ö.Giriş: Takayasu arteriti (TA), büyük damarları etkileyen nadir bir vaskülittir.Amaç: Kronik aerobik egzersiz uygulamasının TA hastalığında olası koruyucu etkisininaraştırılması.Yöntem: Araştırmaya 20-55 yaş arasında 17 kadın TA hastası ve yaş ve Beden Kitle İndeksi(BKİ) eşleştirilmiş 11 kadın sağlıklı kontrol dahil edilmiştir (KON). TA hastaları; egzersizyapmayan grup (TAK, n=9) ve 12 hafta süreyle egzersiz yapan grup (TAK+Egz, n=8) olarakayrılmışlardır. Çalışma iki aşama olarak bazal ve deney sonu ölçümleri şeklindeplanlanmıştır; her iki aşamada da bütün katılımcılar antropometrik ölçümler, koşu bandıüzerinde kardiyopulmoner egzersiz testi (KPET), yakın kızılötesi spektroskopisi (NIRS)ölçümü, akım aracılı dilatasyon (FMD) ölçümleri, kan örnekleri, yaşam kalitesi anketi içinteste tabii tutulmuşlardır. Bazal ölçümleri alındıktan sonra TAK+Egz grubu 12 haftalıksüreçte haftada 3 gün ortayüksek şiddette zumba egzersizi yapmıştır. KON ve TAK grubuyapılandırılmış herhangi bir fiziksel aktiviteye katılmamışlardır.Bulgular: TAK ve TAK+Egz gruplarının maksimum oksijen tüketimi (VO2maks) ve%FMD’si bazal ölçümlerde kontrole göre daha düşüktü (p<0.05-0.01); TAK+Egz grubununVO2maks düzeyleri ve %FMD’si yükselmiştir (p<0.05). Anaerobik eşikteki oksijen tüketimi(VO2AT) TAK grubunda ilk ve son ölçümlerde KON grubundan daha düşüktü, TAK+Egzgrubunda ise egzersiz sonrasında bazale göre VO2AT değerleri yükselmiştir (p<0.05-0.01).İlk ölçümlerde TAK ve TAK+Egz grubunun maksimum kalp hızı (KHmaks) değerlerikontrolden daha düşükken egzersiz antrenmanıyla TAK+Egz grubunda ilk ölçüme kıyasla sonölçümde artmıştır (p<0.05). NIRS ölçümlerinde KON grubuna kıyasla TA gruplarında birfarklılık görülmezken, TAK+Egz grubunda egzersizle birlikte izometrik egzersizi sırasındaminimum % satürasyon ve derlenmede ortalama satürasyon artmıştır (p<0.05).Tartışma ve Sonuç: Çalışmamız egzersiz antrenmanının TA’de kardiyopulmoner sağlamlığıarttırdığını ve vasküler fonksiyonu iyileştirdiğini düşündürmektedir.Anahtar Sözcükler: Takayasu arteriti, egzersiz, endotelyal fonksiyon, VO2maks, anaerobikeşik.Publication Metadata only No association of PTPN22 gene polymorphism with rheumatoid arthritis in Turkey(SPRINGER HEIDELBERG, 2009) GÜNDÜZ, FEYZA; Sahin, N.; Gunduz, F.; Inanc, N.; Direskeneli, Haner; Saruhan-Direskeneli, G.Although the association of rheumatoid arthritis (RA) with HLA-DRB1 (shared epitope) is well demonstrated in many ethnic populations, the role of other RA-associated risk loci is not clarified. In this study, the functional single nucleotide polymorphism (SNP) of PTPN22 gene was investigated in Turkey. 167 patients with RA and 177 healthy controls are genotyped by polymerase chain reaction (PCR)-RFLP for the SNP (rs2476601, A/G) of PTPN22 gene. Polymorphic region was amplified by PCR and digested with Xcm I enzyme. Heterozygous genotype (AG) was present in 5.1% (9/177) of the controls and in 6.6% (11/167) of RA group (p = 0.55, OR 1.3, 95% CI 0.53-3.26). There was also no association between any clinical feature, RF positivity and presence of this SNP. In conclusion, the distribution of PTPN22 polymorphism did not reveal any association with RA in Turkey.