Person: ALİBAZ ÖNER, FATMA
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ALİBAZ ÖNER
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FATMA
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Publication Open 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.Publication Metadata only Moderation analysis exploring associations between age and mucocutaneous activity in Behcet's syndrome: A multicenter study from Turkey(WILEY, 2020) AKSOY, AYSUN; Mumcu, Gonca; Yay, Meral; Karacayli, Umit; Aksoy, Aysun; Tas, Mehmet Nedim; Armagan, Berkan; Sari, Alper; Bozca, Burcin Cansu; Tekgoz, Emre; Temiz Karadag, Duygu; Badak, Suade ozlem; Tecer, Duygu; Yildirim, Alper; Bes, Cemal; Sahin, Ali; Erken, Eren; Cefle, Ayse; Cinar, Muhammet; Yilmaz, Sedat; Alpsoy, Erkan; Boyvat, Ayse; Senel, Soner; Bilge, Sule Yasar; Kasifoglu, Timucin; Karadag, Omer; Aksu, Kenan; Keser, Gokhan; Alibaz-oner, Fatma; Inanc, Nevsun; Ergun, Tulin; Direskeneli, HanerThe aim of the present study was to examine the effects of age on mucocutaneous activity by using moderation analysis in Behcet's syndrome (BS). In this cross-sectional study, 887 BS patients (female : male, 481:406; mean age, 38.4 +/- 10.9 years) followed in 13 tertiary centers in Turkey were included. Mucocutaneous activity was evaluated by using the Mucocutaneous Index (MI) according to sex and disease course. Moderation analysis was performed to test the effect of age on mucocutaneous activity. A moderator variable is a third variable and affects the relationship between independent and outcome variables. Age was chosen as a potential moderator variable (interaction effect), MI score as the outcome variable and sex as an independent variable in the analysis. The moderation analysis tested the effects of age in three steps: whole BS patient group, patients without systemic involvement and those with systemic involvement. The moderation model was only significant in BS patients with systemic involvement (P = 0.0351), and a significant relationship was observed between female sex and MI score (P = 0.0156). In addition, the interaction plot showed that female patients had increased MI scores compared with male patients, especially in the 28-year-old age group (P = 0.0067). Moreover, major organ involvement was newly diagnosed in the majority of these young female BS patients. Our results suggest that the relationship between sex and mucocutaneous activity was moderated by age in the systemic involvement group. Also, increased mucocutaneous activity may be associated with new major organ involvement in young female BS patients with systemic involvement.Publication Open Access The assessment of contributing factors to oral ulcer presence in Behcet's disease: Dietary and non-dietary factors(AVES, 2018-11-27) AKSOY, AYSUN; Iris, Merve; Ozcikmak, Ezgi; Aksoy, Aysun; Alibaz-Oner, Fatma; Inanc, Nevsun; Ergun, Tulin; Direskeneli, Haner; Mumcu, GoncaObjective: The aim of this study was to assess the contributing factors for oral ulcer activity in Behcet's disease (BD). Methods: Ninety-two patients with BD (F/M: 42/50, mean age: 38.7 +/- 10.02 years) participated in this cross-sectional study. Data regarding disease-related factors, smoking patterns, and self-reported dietary/non-dietary triggering factors for oral ulcer activity were collected by a questionnaire. Treatment protocol was categorized as mild and intensive groups associated with organ involvements. Results: A mild treatment protocol was more common in females (52.4% vs 20%) than in males (p=0.002). During the last three months, the number of oral ulcers in female patients was higher in the mild treatment group (6.4 +/- 6.5) than in the intensive treatment group (3.3 +/- 4.9) (p=0.045). In patients with active oral ulcers (n=63), rate of being a non-smoker was also higher in females (86.7% vs 63.6%) than in males. Daily frequency of tooth brushing was 1.2 +/- 0.8 in patients with BD, and was higher in females (1.5 +/- 0.9 vs 0.9 +/- 0.6) (p=0.001). Stress and fatigue (78.3%) were reported as the most frequent triggering factors for oral ulcer presence in patients with BD. A total of 148 different dietary factors associated with oral ulcer presence were reported in the study. Conclusion: A mild treatment protocol and being a non-smoker were found to be the contributing factors associated with oral ulcer activity in patients with BD. Being motivated for oral hygiene and being non-smokers were positive health behaviors observed in females. Irrespective of gender, stress and fatigue were defined as the most common self-reported triggering factors for oral ulcer presence in BD. In addition, the roles of some dietary factors were also reported.Publication Open Access Decreasing incidence and severity of Behcet's disease: a changing trend in epidemiological spectrum possibly associated with oral health(TUBITAK SCIENTIFIC & TECHNICAL RESEARCH COUNCIL TURKEY) ALİBAZ ÖNER, FATMA; Mumcu, Gonca; Alibaz Oner, Fatma; Ergun, Tulin; Direskeneli, HanerBehget's disease (BD) is a systemic and inflammatory disorder that is mainly present along the ancient Silk Road, from the Mediterranean Sea to East Asia. A wide range of prevalence figures (0.1-420/100,000) have been reported for BD, also among Turkish populations of similar genetic background living in different countries. Recently, a decline in the incidence of BD and a change of the disease spectrum to less-severe manifestations have been reported from Japan and Korea, two genetically homogenous, affluent populations with limited immigration. It was hypothesized that a decline in infectious diseases, especially dental/periodontal infections, associated with the improvement in oral health, could be a part of these changes in the disease expression. Further epidemiological studies in other populations might demonstrate whether there is a worldwide similar trend and may provide a better understanding of the triggering factors for the onset and course of 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.