Browsing by Author "Erken, Eren"
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Item Behçet disease with vascular involvement: Effects of different therapeutic regimens on the incidence of new relapses(Lippincott Williams & Wilkins, 2015-02) Öner, Fatma Alibaz; Karadeniz, Aslı; Yılmaz, Sema; Balkarlı, Ayşe; Kimyon, Gezmiş; Yazıcı, Ayten; Çınar, Muhammet; Yılmaz, Sedat; Yıldız, Fatih; Bilge, Şule Yaşar; Bilgin, Emre; Omma, Ahmet; Çetin, Gözde Yıldırım; Çağatay, Yonca; Karaaslan, Yaşar; Sayarlıoğlu, Mehmet; Kalyoncu, Umut; Karadağ, Ömer; Kaşifoğlu, Timuçin; Erken, Eren; Pay, Salih; Çefle, Ayşe; Kısacık, Bünyamin; Onat, Ahmet Mesut; Çobankara, Veli; Direskeneli, Haner; Coşkun, Belkıs Nihan; Pehlivan, Yavuz; Uludağ Üniversitesi/Tıp Fakültesi/Romatoloji Anabilim Dalı.; 0000-0003-0298-4157; AAG-7155-2021; AAG-8227-2021; 55646165400; 13205593600Vascular involvement is one of the major causes of mortality and morbidity in Behcet disease (BD). There are no controlled studies for the management of vascular BD (VBD), and according to the EULAR recommendations, only immunosuppressive (IS) agents are recommended. In this study, we aimed to investigate the therapeutic approaches chosen by Turkish physicians during the initial event and relapses of VBD and the association of different treatment options with the relapses retrospectively. Patients with BD (n = 936, female/male: 347/589, mean age: 37.6 +/- 10.8) classified according to ISG criteria from 15 rheumatology centers in Turkey were included. The demographic data, clinical characteristics of the first vascular event and relapses, treatment protocols, and data about complications were acquired. VBD was observed in 27.7% (n = 260) of the patients during follow-up. In 57.3% of the VBD patients, vascular involvement was the presenting sign of the disease. After the first vascular event, ISs were given to 88.8% and AC treatment to 59.8% of the patients. Median duration of AC treatment was 13 months (1-204) and ISs, 22 months (1-204). Minor hemorrhage related to AC treatment was observed in 7 (4.7%) patients. Asecond vascular event developed in 32.9% (n = 86) of the patients. The vascular relapse rate was similar between patients taking only ISs and AC plus IS treatments after the first vascular event (29.1% vs 22.4%, P = 0.28) and was significantly higher in group taking only ACs than taking only ISs (91.6% vs 29.1%, P < 0.001). During follow-up, a third vascular event developed in 17 (n = 6.5%) patients. The relapse rate was also similar between the patients taking only ISs and AC plus IS treatments after second vascular event (25.3% vs 20.8%, P = 0.93). When multivariate analysis was performed, development of vascular relapse negatively correlated with only IS treatments. We did not find any additional positive effect of AC treatment used in combination with ISs in the course of vascular involvement in patients with BD. Severe complications related to AC treatment were also not detected. Our results suggest that short duration of IS treatments and compliance issues of treatment are the major problems in VBD associated with vascular relapses during follow-up.Publication Clinical features of takayasu's arteritis from an inception cohort: Early disease is characterized by 'systemic inflammation'(Wiley, 2016-10-01) Alibaz-Öner, Fatma; Ünal, Ali Uğur; Onat, Ahmet Mesut; Kısacık, Bünyamin; Zengin, Orhan; Karadağ, Ömer; Erden, Abdulsamet; Yarkan, Handan; Akar, Servet; Yıldız, Fatih; Erken, Eren; Özer, Hüseyin; Omma, Ahmet; Özbalkan, Zeynep; Karaaslan, Yaşar; Bes, Cemal; Öner, Sibel Yılmaz; Kanıtez, Nilüfer Alpay; Bayndır, Özün; Yavuz, Şule; Düzgün, Nursen; Tufan, Ayşe Nur; Dalkılıç, Ediz; Yoshifuji, Hajime; Tufan, Abdurrahman; Akyol, Lütfi; Öztürk, Mehmet Akif; Sayarlıoğlu, Mehmet; Aksu, Kenan; Keser, Gökhan; Kiraz, Sedat; Pamuk, Ömer Nuri; Önen, Fatoş; Direskeneli, Haner; Tufan, Ayse Nur; DALKILIÇ, HÜSEYİN EDİZ; Uludağ Üniversitesi/Tıp Fakültesi/Romatoloji Anabilim Dalı.; GHE-4236-2022; CMF-4757-2022Item The cost of care of rheumatoid arthritis and ankylosing spondylitis patients in tertiary care rheumatology units in Turkey(Elsevier, 2011-11) Malhan, Simten; Pay, Salih; Ataman, Şebnem; Dinç, Ayhan; Erken, Eren; Ertenli, İhsan; Ertuǧrul, Esin; Göǧüş, Feride Nur; Hamuryudan, Vedat; İnanç, Murat; Karaaslan, Yaşar; Dalkılıç, Ediz; Uludağ Üniversitesi/Tıp Fakültesi/İç Hastalıkları & Romatoloji Anabilim Dalı.Item The cost of care of rheumatoid arthritis and ankylosing spondylitis patients in tertiary care rheumatology units in Turkey(Clinical & Exper Rheumatology, 2012) Malhan, Simten; Pay, Salih; Ataman, Şebnem; Dinç, Ayhan; Erken, Eren; Ertenli, İhsan; Ertuǧrul, Esin; Göǧüş, Feride Nur; Hamuryudan, Vedat; İnanç, Murat; Karaaslan, Yaşar; Karadağ, Ömer; Karakoç, Yüksel; Keskin, Göksal; Kısacık, Bünyamin; Kiraz, Sedat; Oksel, Fahrettin; Öksüz, Ergün; Pırıldar, Timur; Sarı, İsmail; Soy, Mehmet; Şentürk, Taşkın; Taylan, Ali; Dalkılıç, Ediz; Uludağ Üniversitesi/Tıp Fakültesi.; 6506739457Objectives: To determine the direct and indirect costs due to rheumatoid arthritis (RA) and ankylosing spondylitis (AS) patients in Turkey. Methods: An expert panel was convened to estimate the direct and indirect costs of care of patients with RA and AS in Turkey. The panel was composed of 22 experts chosen from all national tertiary care rheumatology units (n=53). To calculate direct costs, the medical management of RA and AS patients was estimated using "cost-of-illness" methodology. To measure indirect costs, the number of days of sick leave, the extent of disability, and the levels of early retirement and early death were also evaluated. Lost productivity costs were calculated using the "human capital approach", based on the minimum wage. Results: The total annual direct costs were 2,917.03 Euros per RA patient and 3,565.9 Euros for each AS patient. The direct costs were thus substantial, but the indirect costs were much higher because of extensive morbidity and mortality rates. The total annual indirect costs were 7,058.99 Euros per RA patient and 6,989.81 for each AS patient. Thus, the total cost for each RA patient was 9,976.01 Euros and that for an AS patient 10,555.72 Euros, in Turkey. Conclusion: From the societal perspective, both RA and AS have become burden in Turkey. The cost of lost productivity is higher than the medical cost. Another important conclusion is that indirect costs constitute 70% and 66% of total costs in patients with RA and AS, respectively.Publication Identification of susceptibility loci for takayasu arteritis through a large multi-ancestral genome-wide association study(Cell Press, 2021-01-07) Ortiz-Fernandez, Lourdes; Saruhan-Direskeneli, Guher; Alibaz-Oner, Fatma; Kaymaz-Tahra, Sema; Coit, Patrick; Kong, Xiufang; Kiprianos, Allan P.; Maughan, Robert T.; Aydin, Sibel Z.; Aksu, Kenan; Keser, Gokhan; Kamali, Sevil; Inanc, Murat; Springer, Jason; Akar, Servet; Onen, Fatos; Akkoc, Nurullah; Khalidi, Nader A.; Koening, Curry; Karadag, Omer; Kiraz, Sedat; Forbess, Lindsy; Langford, Carol A.; McAlear, Carol A.; Ozbalkan, Zeynep; Yavuz, Sule; Cetin, Gozde Yildirim; Alpay-Kanitez, Nilufer; Chung, Sharon; Ates, Askin; Karaaslan, Yasar; McKinnon-Maksimowicz, Kathleen; Monach, Paul A.; Ozer, Huseyin T. E.; Seyahi, Emire; Fresko, Izzet; Cefle, Ayse; Seo, Philip; Warrington, Kenneth J.; Ozturk, Mehmet A.; Ytterberg, Steven R.; Cobankara, Veli; Onat, Ahmet Mesut; Duzgun, Nursen; Bicakcigil, Muge; Yentur, Sibel P.; Lally, Lindsay; Manfredi, Angelo A.; Baldissera, Elena; Erken, Eren; Yazici, Ayten; Kisacik, Bunyamin; Kasifoglu, Timucin; Dalkilic, Ediz; Cuthbertson, David; Pagnoux, Christian; Sreih, Antoine; Reales, Guillermo; Wallace, Chris; Wren, Jonathan D.; Cunninghame-Graham, Deborah S.; Vyse, Timothy J.; Sun, Ying; Chen, Huiyong; Grayson, Peter C.; Tombetti, Enrico; Jiang, Lindi; Mason, Justin C.; Merkel, Peter A.; Direskeneli, Haner; Sawalha, Amr H.; 0000-0002-0247-4280; 0000-0003-0660-764X; 0000-0003-4153-903X; 0000-0001-7289-1816; 0000-0002-6376-5583; 0000-0002-3734-1242; 0000-0002-6341-2622; 0000-0002-3718-171X; 0000-0002-8270-2617; 0000-0003-1372-1555; 0000-0003-1185-5816; 0000-0003-4937-0515; 0000-0001-8764-4543; 0000-0003-4965-2918; 0000-0002-8914-9690; 0000-0001-7708-2487; 0000-0002-4530-7167; 0000-0002-7054-1203; 0000-0003-2167-4509; 0000-0002-3785-9834; 0000-0001-6287-9549; 0000-0002-7864-0185; 0000-0001-9993-3916; 0000-0001-9755-1703; 0000-0003-2776-3545; 0000-0003-1123-1464; 0000-0002-7122-9713; 0000-0001-7783-1660; 0000-0001-9284-7345; 0000-0003-2598-5806; GPP-1272-2022; CAG-1626-2022; ISU-1002-2023; D-2668-2012; AAA-6647-2020; AAT-3653-2020; HLH-8218-2023; AAT-3636-2020; KLZ-4006-2024; W-7332-2019; D-9870-2011; GOJ-7451-2022; C-4612-2015; KHW-8303-2024; AAD-5448-2019; AAA-8970-2021; P-4517-2015; L-1241-2015; HJI-6996-2023; JFJ-3399-2023; AAB-3576-2020; C-7018-2014; K-5378-2018Takayasu arteritis is a rare inflammatory disease of large arteries. We performed a genetic study in Takayasu arteritis comprising 6,670 individuals (1,226 affected individuals) from five different populations. We discovered HLA risk factors and four non-HLA susceptibility loci in VPS8, SVEP1, CFL2, and chr13q21 and reinforced IL12B, PTK2B, and chr21q22 as robust susceptibility loci shared across ancestries. Functional analysis proposed plausible underlying disease mechanisms and pinpointed ETS2 as a potential causal gene for chr21q22 association. We also identified >60 candidate loci with suggestive association (p < 5 x 10(-s)) and devised a genetic risk score for Takayasu arteritis. Takayasu arteritis was compared to hundreds of other traits, revealing the closest genetic relatedness to inflammatory bowel disease. Epigenetic patterns within risk loci suggest roles for monocytes and B cells in Takayasu arteritis. This work enhances understanding of the genetic basis and pathophysiology of Takayasu arteritis and provides clues for potential new therapeutic targets.Publication Identification of susceptibility loci in IL6, RPS9/LILRB3, and an intergenic locus on chromosome 21q22 in Takayasu Arteritis in a genome-wide association study(Wiley, 2015-05-01) Renauer, Paul A.; Saruhan-Direskeneli, Guher; Coit, Patrick; Adler, Adam; Aksu, Kenan; Keser, Gökhan; Alibaz-Öner, Fatma; Aydın, Sibel Z.; Kamali, Sevil; İnanç, Murat; Carette, Simon; Cuthbertson, David; Hoffman, Gary S.; Akar, Servet; Önen, Fatoş; Akkoç, Nurullah; Khalidi, Nader A.; Koening, Curry; Karadağ, Ömer; Kiraz, Sedat; Langford, Carol A.; Maksimowicz-McKinnon, Kathleen; McAlear, Carol A.; Özbalkan, Zeynep; Ateş, Aşkın; Karaaslan, Yaşar; Düzgün, Nursen; Monach, Paul A.; Özer, Hüseyin T. E.; Erken, Eren; Öztürk, Mehmet A.; Yazıcı, Ayten; Cefle, Ayşe; Onat, Ahmet Mesut; Kısacık, Bünyamin; Pagnoux, Christian; Kaşifoğlu, Timuçin; Seyahi, Emire; Fresko, İzzet; Seo, Philip; Sreih, Antoine G.; Warrington, Kenneth J.; Ytterberg, Steven R.; Cobankara, Veli; Cunninghame-Graham, Deborah S.; Vyse, Timothy J.; Pamuk, Ömer N.; Tunç, S. Ercan; Dalkılıç, Ediz; Bıçakçıgil, Müge; Yentur, Sibel P.; Wren, Jonathan D.; Merkel, Peter A.; Direskeneli, Haner; Sawalha, Amr H.; DALKILIÇ, HÜSEYİN EDİZ; Uludağ Üniversitesi/Tıp Fakültesi/Romatoloji Anabilim Dalı.; CMF-4757-2022Objective. Takayasu arteritis is a rare large vessel vasculitis with incompletely understood etiology. This study was undertaken to perform the first unbiased genome-wide association analysis of Takayasu arteritis.Methods. Two independent cohorts of patients with Takayasu arteritis from Turkey and North America were included in our study. The Turkish cohort consisted of 559 patients and 489 controls, and the North American cohort consisted of 134 patients and 1,047 controls of European ancestry. Genotyping was performed using the Omni1-Quad and Omni2.5 genotyping arrays. Genotyping data were subjected to rigorous quality control measures and subsequently analyzed to discover genetic susceptibility loci for Takayasu arteritis.Results. We identified genetic susceptibility loci for Takayasu arteritis with a genome-wide level of significance in IL6 (rs2069837) (odds ratio [OR] 2.07, P = 6.70 x 10(-9)), RPS9/LILRB3 (rs11666543) (OR 1.65, P = 2.34 x 10(-8)), and an intergenic locus on chromosome 21q22 (rs2836878) (OR 1.79, P = 3.62 x 10(-10)). The genetic susceptibility locus in RPS9/LILRB3 lies within the leukocyte receptor complex gene cluster on chromosome 19q13.4, and the disease risk variant in this locus correlates with reduced expression of multiple genes including the inhibitory leukocyte immunoglobulin-like receptor gene LILRB3 (P = 2.29 x 10(-8)). In addition, we identified candidate susceptibility genes with suggestive levels of association (P < 1 x 10(-5)) with Takayasu arteritis, including PCSK5, LILRA3, PPM1G/NRBP1, and PTK2B.Conclusion. Our findings indicate novel genetic susceptibility loci for Takayasu arteritis and uncover potentially important aspects of the pathophysiology of this form of vasculitis.Item Incidence of cyclophosphamide-induced urotoxicity and protective effect of mesna in rheumatic diseases(J Rheumatol Publication, 2015-09) Yılmaz, Neslihan; Emmungil, Hakan; Gücenmez, Sercan; Özen, Gülşen; Yıldız, Fatih; Balkarlı, Ayşe; Kimyon, Gezmiş; Doğan, İsmail; Pamuk, Ömer Nuri; Yaşar, Şule; Çetin, Gözde Yıldırım; Yazıcı, Ayten; Eşmen, Serpil Ergülü; Cağatay, Yonca; Yılmaz, Sema; Cefle, Ayşe; Sayarlıoğlu, Mehmet; Kaşifoğlu, Timuçin; Karadağ, Ömer; KIsacık, Bünyamin; Çobankara, Veli; Erken, Eren; Direskeneli, Haner; Aksu, Kenan; Yavuz, Şule; Coşkun, Belkıs Nihan; Pehlivan, Yavuz; Dalkılıç, Ediz; Uludağ Üniversitesi/Tıp Fakültesi/Romatoloji Anabilim Dalı.; 0000-0003-0298-4157; AAG-8227-2021; AAG-7155-2021; 55646165400; 57220381538; 6506739457Objective. To assess bladder toxicity of cyclophosphamide (CYC) and uroprotective effect of mesna in rheumatic diseases. Methods. Data of 1018 patients (725 women/293 men) treated with CYC were evaluated in this retrospective study. All of the following information was obtained: the cumulative CYC dose, route of CYC administration, duration of therapy, concomitant mesna usage, and hemorrhagic cystitis. Cox proportional hazard model was used for statistics. Results. We identified 17 patients (1.67%) with hemorrhagic cystitis and 2 patients (0.19%) with bladder cancer in 4224 patient-years. The median time for diagnosis to hemorrhagic cystitis was 10 months (4-48) and bladder cancer was 8 years (6-10.9). There were 583 patients (57.2%) who received mesna with intravenous CYC therapy. We observed similar incidence rate for hemorrhagic cystitis in both patient groups concomitantly treated with or without mesna [9/583 (1.5%) vs 8/425 (1.8%) respectively, p = 0.08]. Cumulative CYC dose (HR for 10-g increments 1.24, p < 0.001) was associated with hemorrhagic cystitis. Conclusion. Cumulative dose was the only risk factor for hemorrhagic cystitis in patients treated with CYC. No proof was obtained for the uroprotective effect of mesna in our cohort.