Person: KUTLUĞ AĞAÇKIRAN, SEDA
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KUTLUĞ AĞAÇKIRAN
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SEDA
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Publication Open Access Earlier and more aggressive treatment with biologics may prevent relapses and further new organ involvement in Behçet's disease(2023-03-01) BOZKURT, TUĞÇE; KARABACAK, MURAT; KUTLUĞ AĞAÇKIRAN, SEDA; DİRESKENELİ, RAFİ HANER; ALİBAZ ÖNER, FATMA; BOZKURT T., KARABACAK M., Karatas H., KUTLUĞ AĞAÇKIRAN S., Ergun T., DİRESKENELİ R. H., ALİBAZ ÖNER F.Objective: Immunosuppressives (IS) are the choice of treatment for major organ involvement in Behçet\"s disease (BD). In this study, we aimed to investigate the relapse rate and new major organ development in BD under ISs during long-term follow-up. Methods: The files of 1114 BD patients followed in Marmara University Behçet\"s Clinic were analyzed retrospectively. Patients with a follow-up less than 6 months were excluded. Conventional IS and biologic treatment courses were compared. ‘Events under IS’ were defined as a relapse of the same organ and/or new major organ development in patients receiving ISs. Results: Among 806 patients included in the final analysis (male: 56%, age at diagnosis: 29 (23–35) years, median follow-up time: 68 (33–106) months). Major organ involvement was present in 232 (50.5%) patients at diagnosis, and 227 (49.5%) developed new major organ involvement during follow-up. Major organ involvement developed earlier in males (p = 0.012) and in patients with a first-degree relative history of BD (p = 0.066). ISs were given mostly for major organ involvement (86.8%, n = 440). Overall, 36% of the patients had a relapse or new major organ involvement under ISs (relapse: 30.9%, new major organ involvement: 11.6%.) ‘Events under IS’ (35.5% vs 20.8%, p = 0.004), and relapses (29.3% vs 13.9%, p = 0.001) were more common with conventional ISs compared to biologics. Conclusion: Any major event under ISs was less common with biologics compared to conventional ISs in patients with BD. These results suggest that earlier and more aggressive treatment may be an option in BD patients who had the highest risk for severe disease course.Publication Open Access The intensity or duration of inflammatory back pain has no impact on the detection of sacroiliitis by magnetic resonance imaging in axial spondyloarthritis(2023-06-15) BIYIKLI, ERHAN; BUĞDAYCI, ONUR; KUTLUĞ AĞAÇKIRAN, SEDA; ATAGÜNDÜZ, MEHMET PAMİR; SEVİK G., BIYIKLI E., BUĞDAYCI O., ABACAR K. Y., KUTLUĞ AĞAÇKIRAN S., ÇOLAKOĞLU ÖZKAYA Ş., EKİNCİ G., ATAGÜNDÜZ M. P.Background: Sacroiliac joint (SIJ) magnetic resonance imaging (MRI) is an established tool in the evaluation of patients with axial spondyloarthritis (axSpA). In the validation study of the ASAS classification criteria for axSpA, only 63.1% of patients had sacroiliitis on the SIJ-MRI.[1] Studies that enrolled patients with axSpA based on expert opinion reported the sensitivity of MRI between 35 to 42% in detecting sacroiliitis.[2,3] Objectives: This study aimed to evaluate the temporal relationship between ASAS defined positive MRI and the characteristics of low back pain (LBP) in axSpA. Methods: Following axSpA groups were enrolled in the study whenever an attending physician ordered an SIJ-MRI. Patients fulfilling both the Rudwaleit criteria for inflammatory back pain (IBP) and Amor criteria, patients with a previous classification with either modified New York or ASAS classification criteria.[1] A blinded rheumatologist (GS) recorded the intensity and duration of IBP using a questionnaire before SIJ-MRI. MRI appointments were based on availability. Therefore some patients did not have IBP at acquisition. Two radiologists assessed SIJ-MRIs using the ASAS/OMERACT MRI group definition of active sacroiliitis.[4] In case of discrepant reporting, a third experienced radiologist (GE) adjudicated the SIJ-MRIs. The probability of axSpA is estimated using sum scores for SpA features excluding the SIJ-MRI.[5] The correlation between an ASAS-defined positive MRI and LBP characteristics was analyzed. Results: Fifty-nine patients (32 F/27M) were included. Patient characteristics are given in Table 1. Overall, 28 of 59 patients (47.5%) had a positive SIJ-MRI defined by ASAS. The median duration of LBP was 15 (43) days and the highest intensity of LBP was felt 6.5 ± 1.2 days before the MRI appointment. At acqusition, 13 (22.0%) patients reported no LBP. There was no significant difference between the presence of LBP within 10 days prior to MRI and sacroiliitis on MRI. (p=0.6) (Sacroiliitis in 45.7% with, and 53.8% without LBP) In LBP reporting patients, pain duration and pain VAS score were 3.3 ±2.3 and 7.1 ±1.9 in patients with sacroiliitis, and 8.7 ±3.6 and 6.8 ±1.7 in patients without sacroiliitis on MRI, respectively. (p=0.48, p=0.10) Age, sex, BASDAI, CRP and calculated probability of axSpA had no correlation with the presence of sacroiliitis on MRI. Adding sacroiliitis on SIJ-MRI to axSpA probability score increased the rate of patients with a probability of >90% for axSpA from 71.2 to 83.1% but the rate of sacroiliitis on MRI was similar in all probability groups. Conclusion: These results suggest that the presence of LBP and the duration of intense pain do not affect the detected rate of sacroiliitis on SIJ-MRI in axSPA. The low prevalence of sacroiliitis in this study population implies its value as a classification tool. Further studies with larger sample sizes are needed to clarify the factors affecting the SIJ-MRI findings in axSpA patients.Publication Metadata only Myocardial involvement in Behcet's disease may be higher in patients with Neuro-Behcet's disease: a speckle tracking echocardiographic study(TAYLOR & FRANCIS LTD) ÖZBEN SADIÇ, BESTE; Sunbul, Murat; Midi, Ipek Gursoy; Agackiran, Seda Kutlug; Engin, Esin; Ucem, Selen; Alibaz-Oner, Fatma; Sayar, Nurten; Direskeneli, Haner; Sadic, Beste OzbenBackground Behcet's disease (BD) may present with life threating complications including neurological and cardiovascular involvement. Neuro-Behcet's disease (NBD) is one of the most important causes of morbidity and mortality in patients with BD. The aim of the present study is to investigate whether patients with NBD are different than BD patients with other manifestations in terms of subclinical myocardial dysfunction. Methods Forty patients with NBD (23 female, mean age: 42.4 +/- 9.4 years), 40 patients with BD (9 female, mean age: 39.7 +/- 9.0 years) and 40 controls (20 male, mean age: 41.8 +/- 6.5 years) were consecutively included in the study. All subjects underwent a transthoracic echocardiography for evaluation of left ventricular (LV) and atrial (LA) functions with two-dimensional (2D) speckle tracking echocardiography (STE). Results Baseline characteristics, clinical data, LV dimensions, systolic and diastolic functions were all in normal range among the groups. LV global longitudinal strain (LV-GLS) was significantly lower in patients with NBD and BD patients without neurologic involvement compared to controls. LA conduit strain was significantly lower in patients with NBD compared to controls. Patients with both parenchymal NBD and vascular NBD manifestations had significantly lower LV-GLS and LA conduit strain compared to controls. Linear regression analysis demonstrated that among cardiovascular risk factors only presence of NBD was the independent predictor of LV-GLS. Conclusions BD is associated with impaired LV and LA functions. LV-GLS and LA conduit strains of the patients with NBD were lower. NBD was an independent predictor of LV-GLS, suggesting a link between neurological manifestations and cardiac dysfunction in BD patients.Publication Open Access Re: Risk of hbv reactivation in hbsag negative and antihbc igg positive patients receiving biologic therapy(2023-03-01) KANİ, HALUK TARIK; KARABACAK, MURAT; CÖMERT ÖZER, ELİF; ABACAR, KEREM YİĞİT; KUTLUĞ AĞAÇKIRAN, SEDA; SEVİK, GİZEM; ALİBAZ ÖNER, FATMA; İNANÇ, GÜZİDE NEVSUN; ATAGÜNDÜZ, MEHMET PAMİR; ÖZEN ALAHDAB, YEŞİM; DİRESKENELİ, RAFİ HANER; ATUĞ, ÖZLEN; Ergenç İ., KANİ H. T., KARABACAK M., CÖMERT ÖZER E., Mehdiyev S., Jafarov F., ABACAR K. Y., KUTLUĞ AĞAÇKIRAN S., SEVİK G., Aslan R., et al.