Person: ALİBAZ ÖNER, FATMA
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ALİBAZ ÖNER
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FATMA
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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 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 Metadata only Does illness perception associate with disease symptoms in Behcet's disease?(SPRINGER-VERLAG ITALIA SRL, 2019) ALİBAZ ÖNER, FATMA; Mumcu, Gonca; Yagar, Fedayi; Alibaz-Oner, Fatma; Inanc, Nevsun; Direskeneli, Haner; Ergun, TulinThis study aims to assess the relationship between illness perception and disease course and symptoms in Behcet disease (BD). One hundred ten consecutive BD patients (F/M 50/60, mean age 38.5 +/- 9.88years) and 57 patients with Psoriasis as a disease control group (F/M 28/29, mean age 48.12 +/- 15.52) are included in this cross-sectional study. Illness perception is evaluated using a revised version of the Illness Perception Questionnaire (IPQ-R). In IPQ-R, the identity score reflecting the number of symptoms is higher in BD patients with musculoskeletal involvement than the others (6.77 +/- 2.91 vs. 5.08 +/- 3.3, respectively, p=0.007). The consequences score for musculoskeletal involvement (19.52 +/- 7.03) and timeline (acute/chronic) score for eye involvement (26.67 +/- 4.32) are also higher compared to patients without them (16.37 +/- 5.82 and 22.09 +/- 8.68) (p=0.011 and p=0.038), reflecting negative beliefs about the illness. The score of psychological attribution is higher in patients with psoriasis than BD (p=0.039), whereas the other subgroup scores are lower in patients with psoriasis compared to those of BD (p<0.05). This study provides a patient's perspective in the disease management process of BD using the IPQ-R questionnaire. A patient's own personal beliefs and emotional responses to their symptoms might affect the outcome measures, especially with musculoskeletal symptoms and eye involvement in BD. However, psychological attribution is found to be a prominent issue in psoriasis.Publication Metadata only Venous vessel wall thickness in lower extremity is increased in male patients with Behcet's disease(SPRINGER LONDON LTD, 2019) ALİBAZ ÖNER, FATMA; Alibaz-Oner, Fatma; Ergelen, Rabia; Mutis, Aydan; Erturk, Zeynep; Asadov, Ruslan; Mumcu, Gonca; Ergun, Tulin; Direskeneli, HanerVascular involvement, especially in young males, is seen in up to 40% of the patients with Behcet's disease (BD) and is a major cause of mortality and morbidity. In this study, we investigated vessel wall thickness (VWT) and dilatation in lower extremity veins with Doppler ultrasound (US) in male BD patients. Sixty-one male patients with BD, 37 healthy male controls (HC) and 27 male patients, with ankylosing spondylitis (AS), were included in the study. Venous Doppler US was performed by an experienced radiologist blinded to cases. Bilateral common femoral vein (CFV) wall thickness and great/small saphenous vein (SV) dilatations were assessed. All venous measurements were significantly higher in BD compared to AS and HC (p<0.001 for all). Both right and left extremity CFV thicknesses had a high area under the ROC curve (>0.8). Cut-off values for right and left CFV thicknesses for BD was 0.49 and 0.48mm, respectively. High sensitivity and specificities are observed for both measurements (right CFV: sensitivity 81%, specificity 78.4%; left CFV: sensitivity 82.8%, specificity 81.1%). We found increased CFV thickness in BD patients independent of vascular involvement. As a similar change was not observed in controls, increased CFV thickness may be a specific sign of venous inflammation in BD. Our acceptable sensitivity and specificity values of CFV measurements suggest that assessment of femoral vein thickness with US may be a candidate diagnostic tool, especially in young males suspected of BD.Publication Metadata only Evaluation of asymptomatic venous disease by venous Doppler ultrasonography in patients with Behcet's disease without overt thrombosis(SPRINGER LONDON LTD, 2014) ALİBAZ ÖNER, FATMA; Alibaz-Oner, Fatma; Karatay, Emrah; Akpinar, Ihsan Nuri; Ergun, Tulin; Direskeneli, HanerOne of the major causes of mortality and morbidity in Behcet's disease (BD) is vascular involvement. Limited data suggest a high prevalence of venous insufficiency (VI) and some cases of asymptomatic thrombosis in BD. In this study, we aimed to investigate asymptomatic venous disease by venous Doppler ultrasonography (US) prospectively in patients with BD, without known vascular disease. The study included 93 patients with BD (M/F, 45/48; age, 36.4 +/- 10 years), 97 patients with ankylosing spondylitis (AS) (M/F, 50/47; age, 37.5 +/- 9.5 years), and 43 healthy controls (HC) (M/F, 25/18; age, 34.7 +/- 4.5 years). All patients were examined for the clinical findings of venous thrombosis. Vessels of both upper and lower extremities were examined, while the subjects were in supine position by venous Doppler US. Clinical signs (C), the various etiologies (E), anatomical sites (A), and pathophysiological disorder (P) (CEAP) severity score was used to evaluate the severity of the VI. We did not detect any silent thrombosis in any group. VI findings in lower extremity were detected in 32.2 % (n = 30) in the BD group, 28.8 % (n = 28) in AS group, and 9.3 % (n = 4) in the HC group. Both BD and AS patients had significantly higher VI rates than controls (p = 0.007 and 0.015). Similarly, CEAP severity score in BD (0.34 (0-3)) was significantly higher than controls (0, p = 0.008) but similar to AS (0.18 (0-39), p = 0.18). No correlations were present between C-reactive protein elevation (> 5 mg/L) and VI in both BD (p = 0.546) and AS (p = 0.754). A high prevalence of VI was present in both BD and AS patients without symptomatic thrombosis. Presence of VI also in AS, a disease without a major tendency to venous thrombosis, might suggest that chronic inflammation might cause a mild insufficiency detected only by Power US in venous vessels. Long-term consequences of this finding require further follow-up studies to show whether asymptomatic venous disease is a predictor of future venous thrombotic events in patients with BD.Publication Metadata only Th17-Inducing Conditions Lead to in vitro Activation of Both Th17 and Th1 Responses in Behcet's Disease(TAYLOR & FRANCIS INC, 2017) ALİBAZ ÖNER, FATMA; Deniz, Rabia; Tulunay-Virlan, Aysin; Ozdemir, Filiz Ture; Unal, Ali Ugur; Ozen, Gulsen; Alibaz-Oner, Fatma; Aydin-Tatli, Imren; Mumcu, Gonca; Ergun, Tulin; Direskeneli, HanerObjectives: Interleukin-17 (IL-17) has been associated with the pathogenesis of various autoimmune/inflammatory diseases. The aim of this study was to investigate the expression of Th17-related immunity in an innate immunity-dominated vasculitis, namely Behcet's disease (BD). Methods: Peripheral blood mononuclear cells from 37 patients (age: 38.59.8years) with BD, and 25 healthy controls (HC) (age: 39.19.3years), were cultured in Th17-inducing conditions (IL-6, Phytohemagglutinin (PHA), IL-1, and IL-23) for 6days. Cultured cells were stained with CD4, CD8, CD3, TCR gamma/delta, CD19, interferon- (IFN-), and IL-17 antibodies to determine the intracellular cytokine secretion by flow cytometry. Results: IL-17 expression by CD8+ and + T cells was higher in BD compared to HC (p=0.004, p=0.003, respectively). No differences were observed between the groups in the IL-17 production by B cells. Under Th17-inducing conditions, production of IFN- by CD4+, CD8+, and + T cells was also higher in BD compared to HC (p<0.05 in all). Conclusion: Our results suggest that under Th17-stimulating conditions, T cells express both IL-17 and IFN- in BD. More prominent IL-17 and IFN- production by all lymphocyte subsets in BD might be associated with the increased innate responses, early tissue neutrophil infiltrations and late adaptive immunity in BD.Publication Metadata only Unmet need in Behcet's disease: most patients in routine follow-up continue to have oral ulcers(SPRINGER LONDON LTD, 2014) ALİBAZ ÖNER, FATMA; Alibaz-Oner, Fatma; Mumcu, Gonca; Kubilay, Zeynep; Ozen, Gulsen; Celik, Gulce; Karadeniz, Asli; Can, Meryem; Oner, Sibel Yilmaz; Inanc, Nevsun; Atagunduz, Pamir; Ergun, Tulin; Direskeneli, HanerThe clinical course of Behcet's disease (BD) as a multisystemic disorder with a remitting-relapsing nature is insufficiently explored. As complete remission should be aimed in all inflammatory diseases, we investigated the frequency of complete remission in patients with BD followed in long-term, routine practice. In this retrospective study, 258 patients with BD who were regularly followed in outpatient clinics were assessed. The demographic and clinical data for active organ manifestations and treatment protocols were evaluated, and complete remission for this study was defined as no sign of any disease manifestation in the current visit and the preceding month. Two hundred fifty-eight patients with BD (F/M 130/128, mean age 41.1 +/- 11.5 years) were included to the study. Mucocutaneous disease was present in 48.4 % (n = 125). Mean visit number was 6.8 +/- 2.7, and mean follow-up duration was 45.8 +/- 36.5 months. Patients were clinically active in 67.2 % (n = 1,182) of the total visits (n = 1,757), which increased to 75.6 % (68.1-90.3) when the month preceding the visit was also included. The most common active manifestation was oral ulcers (39.4-63.2 %) followed by other mucocutaneous manifestations and musculoskeletal involvement. When multivariate analysis was performed, oral ulcers, which are the main cause of the clinical activity, negatively correlated with immunosuppressive treatments (beta = -0.356, p < 0.000) and age (beta = -0.183, p = 0.04). It is fairly difficult to achieve complete remission in BD with current therapeutic regimens. The reluctance of the clinician to be aggressive for some BD manifestations with low morbidity, such as mucocutaneous lesions and arthritis, might be influencing the continuous, low-disease activity state, especially due to oral ulcers, in BD patients.Publication Metadata only Femoral Vein Wall Thickness Measurement May Be a Distinctive Diagnostic Tool to Differentiate Behcet's Disease with Intestinal Involvement and Crohn's Disease(SPRINGER, 2021) ALİBAZ ÖNER, FATMA; Alibaz-Oner, Fatma; Ergelen, Rabia; Ergenc, Ilkay; Seven, Gizem; Yazici, Ayten; Cefle, Ayse; Bes, Cemal; Atug, Ozlen; Direskeneli, HanerBackgrounds Behcet's disease (BD) and Crohn's disease (CD) cannot be easily differentiated in young adults presenting with nonspecific gastrointestinal (GI) manifestations due to similar extraintestinal manifestations. We recently showed that increased common femoral vein (CFV) thickness is a distinctive feature of BD, rarely present in other inflammatory or vascular diseases with a specificity higher than 80% for the cutoff value of >= 0.5 mm. We suggest that CFV thickness measurement with ultrasonography (US) can be a diagnostic tool for BD. Aims To assess the diagnostic performance of CFV thickness measurement in the differential diagnosis of BD and CD. Methods Patients with BD (n = 69), CD (n = 38), and healthy controls (HC) (n = 38) were included in the study. Bilateral CFV thickness was measured with Doppler US. Results Both right and left CFV thicknesses were significantly higher in BD compared to HC and CD (for right: 0.76 mm vs 0.33 mm, for left: 0.78 mm vs 0.35 mm,p < 0.001 for both). CFV thicknesses in CD were similar to HC (p > 0.05 for both). CFV thickness was also similar between BD patients with and without GI involvement (p = 0.367). The diagnostic cutoff values of >= 0.5 mm for CFV thickness performed well against to both CD and HCs for discrimination of BD. The sensitivity and specificity rates were > 85% for both HC and CD. Positive and negative predictive values in our tertiary clinical setting were > 90%. Conclusion We found significantly lower CFV thickness in CD compared to BD. Our results suggest that CFV wall thickness measurement is a distinctive diagnostic tool for the differentiation of BD and CD and can be helpful in daily practice for the differentiation of two diseases.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 Metadata only The assessment of work productivity and activity impairment in Behcet's disease(TUBITAK SCIENTIFIC & TECHNICAL RESEARCH COUNCIL TURKEY, 2017) ALİBAZ ÖNER, FATMA; Mumcu, Gonca; Lehimci, Fadime; Fidan, Ozlem; Guk, Hulya; Alpar, Ugur; Unal, Ali Ugur; Erturk, Zeynep; Alibaz Oner, Fatma; Inanc, Guzide Nevsun; Ergun, Safiye Atlas Tulin; Direskeneli, Rafi HanerBackground/aim: The aim of this study was to assess the relationships between the course of Behcet's disease (BD), disease-specific fears, and work productivity and activity impairment. Materials and methods: In this cross-sectional study, 110 consecutive BD patients were included. The Work Productivity and Activity Impairment questionnaire was used. Results: In the group of employed patients, 30.41% had missed work during the previous week. The mean percentages of daily activity impairment were higher in patients with musculoskeletal involvement (39.81 +/- 33.61%) compared to those without (23.48 +/- 32.45%) (P = 0.008). A greater decrease in working hours was observed in patients with eye involvement (45.52 +/- 15.29 h) compared to those without (54.15 +/- 15.29 h) (P = 0.007). More of the male patients (67.8%) were afraid of losing their jobs compared to females (30%) (P = 0.000). Conclusion: The highest levels of lost productivity and the most severe effects on daily life are consequences of eye and musculoskeletal involvement in the study population. More effective therapeutic approaches are required to improve the working lives of patients with BD. Moreover, male patients had a higher fear of losing their jobs, suggesting a match between the expected clinical course and the predictions of BD patients.