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 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 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 Childhood-onset versus adult-onset Takayasu arteritis: A study of 141 patients from Turkey(W B SAUNDERS CO-ELSEVIER INC, 2021) ALİBAZ ÖNER, FATMA; Karabacak, Murat; Kaymaz-Tahra, Sema; Sahin, Sezgin; Yildiz, Mehmet; Adrovic, Amra; Barut, Kenan; Direskeneli, Haner; Kasapcopur, Ozgur; Alibaz-Oner, FatmaAim: To compare childhood-onset (c-TAK) versus adult-onset Takayasu arteritis (a-TAK) patients for vascular involvement, disease activity, damage, and treatment. Methods: Patient charts from two tertiary-care centers of a pediatric and adult rheumatology clinic were reviewed. Adult patients diagnosed before the age of 18 years were included in the childhood-onset group. The activity was assessed with the physician's global assessment (PGA) and Indian Takayasu Clinical Activity Score (ITAS). The damage was evaluated with Takayasu Arteritis Damage Score (TADS) and Vasculitis Damage Index (VDI). Results: Twenty-four c-TAK (follow-up duration: 53 months) and 117 a-TAK patients (follow-up duration: 68 months) were analyzed. Aorta involvement was more prevalent (79% vs. 33%), and the median PGA score was higher in the c-TAK group (9 vs. 7), whereas the mean Indian Takayasu Arteritis Score was similar (14 vs. 13) among both groups. Median VDI score was lower for c-TAK patients (4 vs. 5), whereas TADS was similar for children and adults (8 vs. 8). Higher incidence of glucocorticoid related side-effects, a longer time to diagnosis and upper extremity claudication seemed to account for higher VDI scores in adults. Conclusion: Aorta involvement was more common among children with TAK, whereas upper extremities were relatively spared. Biologic agents were used more commonly among children which may be explained by higher rates of aortic involvement. However, c-TAK patients did not have greater cumulative damage. (C) 2020 Elsevier Inc. All rights reserved.Publication Metadata only PRESENCE OF FIBROMYALGIA AND FATIGUE IS NOT INCREASED IN PATIENTS WITH TAKAYASU'S ARTERITIS(BMJ PUBLISHING GROUP, 2013) ALİBAZ ÖNER, FATMA; Alibaz-Oner, F.; Can, M.; Direskeneli, H.Publication Metadata only Predictors for the risk and severity of post-thrombotic syndrome in vascular Behcet's disease(ELSEVIER, 2021) ILGIN, CAN; Aksoy, Aysun; Colak, Seda; Yagiz, Burcu; Coskun, Belkis Nihan; Omma, Ahmet; Yildiz, Yasin; Sari, Alper; Atas, Nuh; Ilgin, Can; Karadag, Omer; Erden, Abdulsamet; Dalkilic, Ediz; Bolca, Naile; Ergelen, Rabia; Onur, Mehmet Ruhi; Direskeneli, Haner; Alibaz-Oner, FatmaObjective: Deep vein thrombosis (DVT) of the lower extremities is the most common form of vascular involvement in Behcet disease (BD), frequently leading to post-thrombotic syndrome (PTS) as a disabling complication. We have described the clinical characteristics and predictors of PTS presence among patients with BD and lower extremity DVT. We also used venous Doppler ultrasound (US) examinations in our assessment. Methods: Patients with BD (n = 205; 166 men, 39 women; age 39 6 9.5 years) and a history of DVT were investigated. The Villalta scale was used to assess the presence and severity of PTS. Doppler US examinations were performed within 1 week of the clinical evaluation. The total number of vessels with reflux, thrombi, recanalization, and collateral vessels were calculated. Results: Of the 205 patients with BD, 62% had had PTS and 18% had had severe PTS. Patients with PTS had had greater reflux (P = .054) and thrombosis (P = .02) scores compared with patients without PTS. Treatment with anticoagulation (AC), immunosuppressive (IS) therapy, or AC combined with IS drugs did not affect the occurrence of PTS. However, patients treated with IS therapy, with or without AC drugs, had a decreased incidence of severe PTS compared with the AC-only group (P = .017). Patients treated with AC plus IS agents also had increased collateral scores compared with patients treated with only IS drugs. Interferon-a use seemed to provide better recanalization scores compared with azathioprine only (1.0 [range, 0-14] vs 2.5 [range, 0-10]; P = .010). Conclusions: Patients with BD and DVT have a high risk of developing severe PTS. IS treatment decreases the development of severe PTS. AC therapy might influence the course of PTS by increasing the collateral scores, and the use of interferon-a also increased recanalization scores. Routine assessment with Doppler US examinations could be helpful in the prediction of severe PTS. (J Vasc Surg Venous Lymphat Disord 2021;9:1451-9.)Publication Metadata only Mo174fibroscan detection of fatty liver and liver fibrosis in systemic lupus erythematosus(2021-05-01) BARUTÇU ATAŞ, DİLEK; VELİOĞLU, ARZU; ARIKAN, İZZET HAKKI; ALİBAZ ÖNER, FATMA; DİRESKENELİ, RAFİ HANER; TUĞLULAR, ZÜBEYDE SERHAN; AŞICIOĞLU, EBRU; Yetginoğlu Ö., BARUTÇU ATAŞ D., VELİOĞLU A., ARIKAN İ. H., YILMAZ Y., ALİBAZ ÖNER F., DİRESKENELİ R. H., TUĞLULAR Z. S., AŞICIOĞLU E.BACKGROUND AND AIMS: Systemic Lupus Erythematosus (SLE) is a chronic, multi-organ, systemic autoimmune disease that is more common in women than men and is typically diagnosed during the reproductive age. Although liver dysfunction is not considered the main organ pathology in SLE, the frequency of liver dysfunction or abnormal liver enzyme values may be observed in 50-60% of patients. Liver-related complications may present as asymptomatic hepatomegaly, subclinical steatosis and abnormal liver enzymes. The most common causes are drug-associated liver injury, lupus-associated hepatitis, and fatty liver disease. The aim of this study was to assess fatty liver and liver fibrosis in SLE patients using the FibroScan method as well as associated factors such as immunosuppressive medications. METHOD: Sixty SLE patients and 30 healthy controls were included. Patients with HBV, HCV or cirrhosis, malignancy, cardiac disease, or patients on dialysis were excluded. All participants underwent FibroScan measurements. Demographic data and cumulative doses of immunosuppressive medications were extracted from patient charts. Fasting blood was collected for analysis RESULTS: Demographic and clinical characteristics of the study groups are shown in Tables 1. The prevalence of fatty liver disease was similar between SLE patients and healthy controls (21.7% vs 26.7%, p= 0.597) and was associated with body mass index (BMI) (p= 0.026) and C-reactive protein (CRP) (p= 0.046) in multivariate analysis. Liver fibrosis was also similar between the two groups (26.7% vs 10.0%, p= 0.069). There was no relationship between cumulative drug doses including glucocorticoids with either fatty liver disease or liver fibrosis. Since the majority of SLE patients were female, we performed a subgroup analysis in female patients (n=51) and healthy controls (n=25). Fatty liver disease was similar between female SLE patients and healthy controls (23.5% vs 24.0%, p= 0.964). However, liver fibrosis in female patients with SLE was increased compared to the female healthy population (29.4% vs 4.0%, p= 0.011) and was associated with age (p= 0.034) and low-dose cumulative glucocorticoid use (p = 0.034). Low-dose cumulative glucocorticoid use was defined as less than 17.45 g, which was the 75th percentile value. Only 1 out of 15 female patients with fibrosis had high-dose cumulative glucocorticoid use (>17.45 g), while the remaining 14 patients had used lower doses (<17.45 g). CONCLUSION: The prevalence of fatty liver was similar between SLE patients and healthy controls, while liver fibrosis was increased in the female patient group as compared to controls. Furthermore, liver fibrosis was associated with age and low dose cumulative glucocorticoid use. Interestingly, fatty liver did not precede liver fibrosis in the majority of cases, contrary to what is observed in the general population. We hypothesized that liver fibrosis may be the result of subclinical inflammation and autoimmunity associated with SLE itself and the use of steroids may prevent or prolong fibrosis formation in the liver.Publication Metadata only Assessment of the New 2012 EULAR/ACR Clinical Classification Criteria for Polymyalgia Rheumatica: A Prospective Multicenter Study(J RHEUMATOL PUBL CO, 2016) ALİBAZ ÖNER, FATMA; Ozen, Gulsen; Inanc, Nevsun; Unal, Ali Ugur; Bas, Seda; Kimyon, Gezmis; Kisacik, Bunyamin; Onat, Ahmet Mesut; Murat, Sadiye; Keskin, Havva; Can, Meryem; Mengi, Alperen; Cakir, Necati; Balkarli, Ayse; Cobankara, Veli; Yilmaz, Neslihan; Yazici, Ayten; Dogru, Atalay; Sahin, Mehmet; Sahin, Ali; Gok, Kevser; Senel, Soner; Pamuk, Omer Nuri; Yilmaz, Sema; Bayindir, Ozun; Aksu, Kenan; Cagatay, Yonca; Akyol, Lutfi; Sayarlioglu, Mehmet; Yildirim-Cetin, Gozde; Yasar-Bilge, Sule; Yagci, Ilker; Aydin, Sibel Zehra; Alibaz-Oner, Fatma; Atagunduz, Pamir; Direskeneli, HanerObjective. To assess the performance of the new 2012 provisional European League Against Rheumatism (EULAR)/ American College of Rheumatology (ACR) polymyalgia rheumatica (PMR) clinical classification criteria in discriminating PMR from other mimicking conditions compared with the previous 5 diagnostic criteria in a multicenter prospective study. Methods. Patients older than 50 years, presenting with new-onset bilateral shoulder pain with elevated acute-phase reactants (APR), were assessed for the fulfillment of the new and old classification/diagnostic criteria sets for PMR. At the end of the 1-year followup, 133 patients were diagnosed with PMR (expert opinion) and 142 with non-PMR conditions [69 rheumatoid arthritis (RA)]. Discriminating capacity, sensitivity, and specificity of the criteria sets were estimated. Results. Discriminating capacity of the new clinical criteria for PMR from non-PMR conditions and RA as estimated by area under the curve (AUC) were good with AUC of 0.736 and 0.781, respectively. The new criteria had a sensitivity of 89.5% and a specificity of 57.7% when tested against all non-PMR cases. When tested against all RA, seropositive RA, seronegative RA, and non-RA control patients, specificity changed to 66.7%, 100%, 20.7%, and 49.3%, respectively. Except for the Bird criteria, the 4 previous criteria had lower sensitivity and higher specificity (ranging from 83%-93%) compared with the new clinical criteria in discriminating PMR from all other controls. Conclusion. The new 2012 EULAR/ ACR clinical classification criteria for PMR is highly sensitive; however, its ability to discriminate PMR from other inflammatory/noninflammatory shoulder conditions, especially from seronegative RA, is not adequate. Imaging and other modifications such as cutoff values for APR might increase the specificity of the criteria.Publication Metadata only Patient-reported outcomes in Takayasu's arteritis(MASSON EDITEUR, 2017) ALİBAZ ÖNER, FATMA; Alibaz-Oner, Fatma; Sreih, Antoine G.; Merkel, Peter A.; Direskeneli, HanerPatient-reported outcomes (PROs) are assessment tools coming directly from patients about their feelings, perceptions, health-related functions, and treatment effects without interpretation by health-care providers. There is a global interest for more patient-centered care'' and PROs in rheumatology. Assessment of disease impact through patient-reported outcome (PRO) measures is a key element for clinical care and clinical research in Takayasu's arteritis (TAK). Currently there are no disease-specific PRO measures to assess quality of life for patients with TAK. Impaired health-related quality of life (HRQoL), functional status, increased anxiety, and depression were shown in patients with TAK in a few studies with generic PRO instruments such as the Short Form-36. However, it is difficult to capture disease-specific effects on patients' daily life and quality of life with these generic tools. There are ongoing efforts of Outcome Measures in Rheumatology (OMERACT) Vasculitis Working Group to develop disease-specific outcome measures in TAK.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.