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DİRESKENELİ, RAFİ HANER

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DİRESKENELİ

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RAFİ HANER

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2020 - 202479
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    PublicationOpen Access
    Impact of concomitant obstructive sleep apnea on pulmonary involvement and main pulmonary artery diameter in adults with scleroderma
    (SPRINGER HEIDELBERG, 2021-03) BALCAN, MEHMET BARAN; Yakut, Tugce; Balcan, Baran; Karakurt, Sait; Direskeneli, Haner; Yalcinkaya, Yasemin; Peker, Yuksel
    Purpose Pulmonary involvement is common in adults with scleroderma. The effect of concomitant obstructive sleep apnea (OSA) on risk for pulmonary hypertension in scleroderma is unknown. An enlarged main pulmonary artery diameter (mPAD) derived from chest computer tomography (CT) is a useful predictor of pulmonary hypertension. We addressed the effect of OSA on pulmonary involvement and enlarged mPAD in adults with scleroderma. Methods All participants underwent pulmonary function testing, carbon monoxide diffusion capacity, chest CT, and overnight sleep recording with home sleep apnea testing. OSA diagnosis was based on an apnea-hypopnea index (AHI) >= 15/h. Oxygen desaturation index (ODI) was also recorded. Scleroderma involvement of the lungs was defined as the Warrick score >= 7 based on the CT findings. Enlarged mPAD was defined as an mPAD >= 29 mm in men and >= 27 mm in women. Results After exclusions, 62 patients (58 women) were included. OSA was found among 20 (32%), 17/42 (38%) in the limited cutaneous type, and 3/20 (15%) in the diffuse cutaneous type (p = 0.08). Scleroderma involvement of the lungs was observed in 40 participants (65% in OSA vs 64% in no-OSA; n.s.). Enlarged mPAD was measured in 16 participants, 10 of 20 (50%) in the OSA group and 6 of 17 (14%) in the no-OSA group (p = 0.003). OSA was associated with enlarged mPAD (odds ratio 4.7, 95% confidence interval 1.1-20.9; p = 0.042) independent of age, body mass index, and pulmonary involvement. There was a linear relationship between mPAD and AHI (r = 0.37; p = 0.003) as well as ODI (r = 0.41; p < 0.001). Conclusions In this cohort, OSA was associated with risk for pulmonary hypertension independent of pulmonary involvement. These findings suggest that assessing the effect of therapy for concomitant OSA in patients with scleroderma is warranted.
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    PublicationOpen Access
    Advances in the Treatment of Behcet's Disease
    (SPRINGER, 2021-06) ALİBAZ ÖNER, FATMA; Alibaz-Oner, Fatma; Direskeneli, Haner
    Purpose of Review To assess current management of Behcet's disease (BD). Controversies on therapeutic approaches to different manifestations, whether conventional immunosuppressives (IS) or biologic agents, should be chosen, and options for refractory disease are discussed. Recent Findings Glucocorticoids are still the main agents for remission-induction and azathioprine the first-line conventional IS in maintenance phase to prevent relapses of major organ involvement. Apremilast is shown to be a safe and effective option approved by the FDA for oral ulcers. Large case series confirmed the efficacy and safety of TNF alpha inhibitors and Interferon-alpha. Promising results are observed with IL-1 inhibitors, ustekinumab, secukinumab, and tocilizumab for refractory BD. Although both conventional IS and biologic agents are effectively used to suppress inflammation in BD, there is still an unmet need for clear therapeutic strategies in the management for different manifestations. Further controlled studies with new biologic agents, anticoagulants and the benefit of concomitant IS usage with biologics are needed to optimize the management of BD.
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    PublicationOpen Access
    Biologic treatments in Behcet's disease
    (AVES, 2021-11-22) ALİBAZ ÖNER, FATMA; Alibaz-Oner, Fatma; Direskeneli, Haner
    Behcet's disease (BD) significantly increases morbidity and mortality, especially in young men. While vascular involvement is the most frequent cause of mortality, ocular involvement, which can cause visual loss, is the most important cause of morbidity in BD. Immunosuppressive treatment is the mainstay for major organ involvement. However, despite optimal immunosuppressive treatment, relapses and disease-related damage develop in a subgroup of patients, especially among those with ocular or vascular involvement. With the recent understanding of the immuno-pathogenesis, biologic treatments targeting potential pathogenic cells, cytokines or pathways are better optimized in BD. Data from large series showed that tumor necrosis factor-alpha inhibitors and interferon-alpha are effective and safe treatment options for the treatment of refractory and major organ involvement, such as ocular, neurologic, vascular, and gastrointestinal. Anakinra and ustekinumab also seem to be promising agents for refractory mucocutaneous disease. IL-1 inhibitors and tocilizumab may be alternatives for the treatment of patients with refractory eye involvement. Still, randomized controlled trials of biologic agents, especially for the treatment of major organ involvement, are insufficient, and further prospective, long-term follow-up studies are needed to clarify the efficacy, safety, and optimal treatment duration of biologic agents in BD.
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    Secukinumab and infectious adverse effects: A real-life experience of 63 psoriasis patients
    (2021) SEÇKİN GENÇOSMANOĞLU, DİLEK; Ergun, Tulin; Seckin, Dilek; Demir, Gizem; Direskeneli, Haner
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    PublicationOpen Access
    Pulmonary artery wall thickness is increased in behcet's disease
    (2022-06-01) DİRESKENELİ, RAFİ HANER; ALİBAZ ÖNER, FATMA; Agackiran S. K. , Sunbul M., Kocakaya D., Kayaci S., DİRESKENELİ R. H. , Alibaz-Oner F.
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    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, Haner
    Objectives. 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.
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    PublicationOpen Access
    EULAR recommendations for the use of imaging in large vessel vasculitis in clinical practice: 2023 update
    (2023-08-07) DİRESKENELİ, RAFİ HANER; Dejaco C., Ramiro S., Bond M., Bosch P., Ponte C., Mackie S. L., Bley T. A., Blockmans D., Brolin S., Bolek E. C., et al.
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    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.
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    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.
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    PublicationOpen Access
    Vascular Behcet's disease: a comparative study from Turkey and France
    (2022-08-01) ALİBAZ ÖNER, FATMA; DİRESKENELİ, RAFİ HANER; Alibaz-Oner F., Vautier M., Aksoy A., Mirouse A., Le Joncour A., Cacoub P., Ilgin C., Saadoun D., DİRESKENELİ R. H.
    Objective Vascular Behcet\"s disease (VBD) is a systemic vasculitis involving both arterial and venous vessels of all sizes and occurring in up to 40% of patients with BD. VBD is the main cause of mortality in BD. Although commonly seen around the Mediterranean region, comparative studies in VBD are lacking. We aimed to compare the course and therapeutic approaches of VBD in two large cohorts from Turkey and France. Methods We included 291 VBD patients (female/male:63/228, mean age: 41.2 +/- 11.3 years) who were followed up in the Department of Internal Medicine and Clinical Immunology at Pitie-Salpetriere Hospital, Sorbonne University, Paris, France (n=131) and Rheumatology Division of Marmara University School of Medicine, Istanbul, Turkey (n=160). All clinical and demographical data were acquired from patient charts retrospectively. Results Smoking, family history for BD, HLA-B*51 presence and pathergy positivity were significantly higher in Turkish patients (TR), while neurologic involvement was more prominent in the French (FR) group. After a median follow-up of 77 months, 562 vascular events occurred including 440 venous events, 115 arterial events and 7 cardiac thrombi. In 79 (29%) patients, first vascular event developed before BD diagnosis and for 77 (28%) of them, vascular involvement was the presenting sign of the disease. First relapse developed in 130 (44.7%) patients after median 24.5 (1-276) months of follow-up (TR: 46.3% (n=74), FR: 42.7% (n=56), p=0.56). Survival graph revealed that FR cohort has 1.64 times increased recurrent event risk compared to TR cohort (HR=1.64 (1.1-2.44), p=.014) and although did not reach to statistical significance, IS treatment after the first vascular event decreased further vascular events (HR= 0.66 (0.43-1.01, p=.057). Conclusion Almost half of patients relapsed of VBD within 2 years after the first vascular event. Immunosuppressants decrease VBD relapses.