1
|
Ozen G, Pedro S, Michaud K. Major adverse cardiovascular events and mortality with opioids versus NSAIDs initiation in patients with rheumatoid arthritis. Ann Rheum Dis 2023; 82:1487-1494. [PMID: 37460169 DOI: 10.1136/ard-2023-224339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 07/03/2023] [Indexed: 10/14/2023]
Abstract
OBJECTIVE Assess major adverse cardiovascular event (MACE) risk with opioids compared with non-steroidal anti-inflammatory drugs (NSAIDs) in patients with rheumatoid arthritis (RA) METHODS: We conducted a new-user active comparator cohort study among patients with RA within FORWARD, The National Databank for Rheumatic Diseases, with ≥1 year participation between 1998 and 2021. Each opioid initiator was matched to two NSAID initiators by propensity scores (PSs). Patients were followed until the occurrence of the composite endpoint of MACE (myocardial infarction, stroke, heart failure, cardiovascular disease (CVD) death, venous thromboembolism (VTE)) and all-cause mortality. The risk of outcomes was estimated using Cox proportional hazards with adjustment for PS weights and imbalanced covariables. RESULTS Among 6866 opioid initiators and 13 689 NSAID initiators, 212 vs 253 MACE (20.6/1000 person-years (PY) vs 18.9/1000 PY) and 144 vs 150 deaths (13.5/1000 PY vs 10.8/1000 PY) occurred, respectively. The risk of MACE with opioids was similar to NSAIDs (HR=1.02, 95% CI 0.85 to 1.22), whereas all-cause mortality with opioids was 33% higher than NSAIDs (HR=1.33, 95% CI 1.06 to 1.67) in PS-weighted models. Among the individual outcomes of MACE, VTE risk tended to be higher in opioid initiators than NSAID initiators (HR=1.41, 95% CI 0.84 to 2.35). Strong opioids had a higher risk for all-cause mortality and VTE than weak opioids compared with NSAIDs suggesting a dose-dependent association. CONCLUSION Opioids had similar MACE risk compared with NSAIDs in patients with RA with increased all-cause mortality and likely VTE, which suggests that opioids are not safer than NSAIDs, as clinicians have perceived.
Collapse
Affiliation(s)
- Gulsen Ozen
- Rheumatology, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Sofia Pedro
- FORWARD, The National Databank for Rheumatic Diseases, Wichita, Kansas, USA
| | - Kaleb Michaud
- Rheumatology, University of Nebraska Medical Center, Omaha, Nebraska, USA
- FORWARD, The National Databank for Rheumatic Diseases, Wichita, Kansas, USA
| |
Collapse
|
2
|
Ozen G, Dell'Aniello S, Pedro S, Michaud K, Suissa S. Reduction of Cardiovascular Disease and Mortality Versus Risk of New-Onset Diabetes Mellitus With Statin Use in Patients With Rheumatoid Arthritis. Arthritis Care Res (Hoboken) 2023; 75:597-607. [PMID: 35119769 DOI: 10.1002/acr.24866] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 01/17/2022] [Accepted: 01/17/2022] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To assess the effect of statin use on the risk of cardiovascular disease (CVD), all-cause mortality, and type 2 diabetes mellitus (DM) in patients with rheumatoid arthritis (RA). METHODS We identified a cohort of patients with RA between 1989 and 2018, within the UK Clinical Practice Research Datalink. We employed a prevalent new-user cohort design by which patients initiating statins were each matched to 2 concurrent nonusers by the time-conditional propensity score (TCPS). Patients were followed until the occurrence of the composite end point of myocardial infarction, stroke, hospitalized heart failure or CVD mortality, all-cause mortality, and incident type 2 DM. The Cox proportional hazards model was used to estimate the hazard ratio (HR) of each outcome associated with as-treated statin use, with adjustment for TCPS deciles and imbalanced covariables. RESULTS Among 1,768 statin initiators and 3,528 nonusers, 63 versus 340 CVD (3.0 per 100 person-years versus 2.7 per 100 person-years) and 62 versus 525 deaths (2.8 per 100 person-years versus 4.1 per 100 person-years) occurred. Incident type 2 DM was noted in 128 of 3,608 statin initiators (3.0 per 100 person-years) and 518 of 7,208 nonusers (2.0 per 100 person-years). Statin initiation was associated with 32% (HR 0.68 [95% confidence interval (95% CI) 0.51-0.90]) reduction in CVD, 54% (HR 0.46 [95% CI 0.35-0.60]) reduction in all-cause mortality, and 33% increase in type 2 DM (HR 1.33 [95% CI 1.09-1.63]). The number needed to treat/number needed to harm to prevent a CVD or all-cause mortality or to cause type 2 DM in 1 year was 102, 42, and 127, respectively. CONCLUSION Statins are associated with important reductions in CVD and mortality that outweigh the modest increase in type 2 DM risk in RA patients.
Collapse
Affiliation(s)
- Gulsen Ozen
- University of Nebraska Medical Center, Omaha
| | | | - Sofia Pedro
- FORWARD, The National Databank for Rheumatic Diseases, Wichita, Kansas
| | - Kaleb Michaud
- University of Nebraska Medical Center, Omaha, and FORWARD, The National Databank for Rheumatic Diseases, Wichita, Kansas
| | - Samy Suissa
- Jewish General Hospital and McGill University, Montreal, Quebec, Canada
| |
Collapse
|
3
|
Kumthekar A, Pedro S, Michaud K, Ozen G, Katz P, Baker J, Ogdie A. Physical Activity Habits Among Older Adults Living With Rheumatic Disease. J Rheumatol 2023:jrheum.211244. [PMID: 36642435 DOI: 10.3899/jrheum.211244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
OBJECTIVE To describe levels of physical activity (PA) in older adults with rheumatic and musculoskeletal diseases (RMDs) and study the association between PA level and patient-reported outcomes. METHODS Using data from FORWARD, a cross-sectional analysis was performed among adults aged 65 years and older with RMDs to assess the levels of PA. PA was categorized as high (vigorously active for at least 30 minutes, 3 times per week), moderate (moderately active for at least 3 times per week) or low (seldom active). We assessed the self-reported levels of PA among patients with different types of RMDs and assessed the association between levels of PA and PROs, including the 29-item Patient Reported Outcomes Measurement Information System (PROMIS-29) assessment. RESULTS Among the 3343 eligible participants, rheumatoid arthritis (68%) was the most common RMD. High PA was reported by 457 (13.6%) participants, and 1820 (54.4%) reported moderate activity. Overall, participants reported a median of 7 (IQR 0-15) days of moderate to vigorous level of PA for ≥ 30 min per month. Obese participants were significantly more likely to report low levels of activity (44% of obese compared to 25% of nonobese individuals). Participants with low PA levels had higher (worse) pain scores, higher (worse) Health Assessment Questionnaire-Disability Index scores, higher depression rates, and worse PROMIS-29 scores related to pain, sleep and fatigue. CONCLUSION Among patients with RMDs, levels of high PA were relatively low among older patients. These observations, though descriptive, support a relationship between physical inactivity and obesity, depression, poor sleep, and fatigue in patients with RMDs.
Collapse
Affiliation(s)
- Anand Kumthekar
- A. Kumthekar, MD, Division of Rheumatology, Department of Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, New York, New York
| | - Sofia Pedro
- S. Pedro, PhD, FORWARD/The National Databank of Rheumatic Diseases, Wichita, Kansas
| | - Kaleb Michaud
- K. Michaud, PhD, FORWARD/The National Databank of Rheumatic Diseases, Wichita, Kansas, and Division of Rheumatology, Department of Medicine, University of Nebraska Medical Center, Omaha, Nebraska
| | - Gulsen Ozen
- G. Ozen, MD, Division of Rheumatology, Department of Medicine, University of Nebraska Medical Center, Omaha, Nebraska
| | - Patricia Katz
- P. Katz, PhD, Division of Rheumatology, Department of Medicine, University of California, San Francisco, California
| | - Joshua Baker
- J. Baker, MD, MSCE, Division of Rheumatology, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Alexis Ogdie
- A. Ogdie, MD, MSCE, Division of Rheumatology, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| |
Collapse
|
4
|
Korkmaz FN, Ozen G, Unal AU, Odabasi A, Can M, Asıcıoglu E, Tuglular S, Direskeneli H. Vitamin D levels in patients with small and medium vessel vasculitis. Reumatol Clin (Engl Ed) 2022; 18:141-146. [PMID: 35277211 DOI: 10.1016/j.reumae.2020.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Accepted: 11/12/2020] [Indexed: 06/14/2023]
Abstract
OBJECTIVES To determine the prevalence of vitamin D deficiency in patients with small and medium vessel systemic vasculitis. METHODS In this cross-sectional study, 25-hydroxy (OH) vitamin D3 levels were measured in adult patients with systemic small and medium vessel vasculitis including antineutrophil cytoplasmic antibody-associated vasculitis (AAV), cryoglobulinaemic vasculitis (CryV), IgA vasculitis (IgAV) and polyarteritis nodosa (PAN), and age- and sex-matched healthy subjects (HS) and patients with rheumatoid arthritis (RA) as control groups. 25OH vitamin D3 levels<30ng/ml and <20ng/ml were regarded as insufficiency and deficiency, respectively. RESULTS Fifty-seven patients (42 AAV, 2 CryV, 8 IgA vasculitis, 5 PAN) with systemic vasculitis, 101 HS, and 111 RA patients were included. The mean 25OH vitamin D3 level was 21.8±14.2ng/mL in patients with vasculitis, 42.7±27.6ng/mL in HS (p<.001) and 20.1±18.47ng/mL in patients with RA (p=.54). Vitamin D insufficiency and deficiency were significantly higher in patients with systemic vasculitis compared to HS (75.4% vs 33.7%, p<.001; %50 vs 21.8%, p<.001, respectively). Vitamin D status was not different in patients with systemic vasculitis compared to RA. There was a negative correlation between vitamin D status and CRP levels (=-.364, p=.007). The multivariate logistic regression analysis showed that renal involvement was significantly associated with vitamin D deficiency/insufficiency in patients with vasculitis (OR 22.5 [95% CI 1.6-128.9]. CONCLUSION Vitamin D deficiency and insufficiency are more frequent in patients with systemic small and medium vessel vasculitis and RA than HS. Renal involvement is one of the factors associated with vitamin D deficiency/insufficiency in patients with vasculitis.
Collapse
Affiliation(s)
- Fatma Nur Korkmaz
- Ankara University, School of Medicine, Department of Internal Medicine, Division of Endocrinology, Ankara, Turkey.
| | - Gulsen Ozen
- University of Nebraska Medical Center, Department of Internal Medicine, Omaha, NE, USA
| | - Ali Ugur Unal
- Marmara University, School of Medicine, Department of Internal Medicine, Division of Rheumatology, Istanbul, Turkey
| | - Asli Odabasi
- Marmara University, School of Medicine, Department of Internal Medicine, Istanbul, Turkey
| | - Meryem Can
- Medipol Mega Hospitals Complex, Department of Rheumatology, İstanbul, Turkey
| | - Ebru Asıcıoglu
- Marmara University, School of Medicine Hospital, Department of Internal Medicine, Division of Nephrology, Istanbul, Turkey
| | - Serhan Tuglular
- Marmara University, School of Medicine Hospital, Department of Internal Medicine, Division of Nephrology, Istanbul, Turkey
| | - Haner Direskeneli
- Marmara University, School of Medicine, Department of Internal Medicine, Division of Rheumatology, Istanbul, Turkey
| |
Collapse
|
5
|
Ozen G, Pedro S, Schumacher R, Simon T, Michaud K. Risk factors for venous thromboembolism and atherosclerotic cardiovascular disease: do they differ in patients with rheumatoid arthritis? RMD Open 2021; 7:rmdopen-2021-001618. [PMID: 34193517 PMCID: PMC8246357 DOI: 10.1136/rmdopen-2021-001618] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 06/14/2021] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE Venous thromboembolism (VTE) is an increasing concern in rheumatoid arthritis (RA) with little known about risk factors. We aimed to compare risk factors for unprovoked VTE and atherosclerotic cardiovascular disease (ASCVD) in patients with RA and to assess subsequent ASCVD risk after an unprovoked VTE. METHODS People with RA participating in a US-wide longitudinal observational registry from 1998 to 2018 were assessed for incident unprovoked VTE (deep venous thrombosis and pulmonary emboli not associated with cancer, recent surgery, hospitalisation, fracture and pregnancy) and ASCVD (myocardial infarction and stroke) validated from hospital/death records. Risk factors for VTE and ASCVD and the risk of ASCVD after an unprovoked VTE were determined using Cox proportional hazards models. RESULTS During median (IQR) 4 (1.5-7) years of follow-up in 31 366 patients with RA, 539 unprovoked VTE and 1648 ASCVD events were identified. The adjusted models showed increased VTE and ASCVD risk with older age, male sex, comorbidities, prior fracture, worse disability, higher disease activity and glucocorticoids. Traditional cardiovascular disease risk factors were common in both ASCVD and VTE but only increased ASCVD risk with obesity as the exception (VTE HR (95% CI), 1.46 (1.13-1.87)) and ASCVD, 0.58 (0.50-0.68)). ASCVD risk doubled after an unprovoked VTE (HR (95% CI), 2.05 (1.43-2.95)). CONCLUSION Our findings suggest that unprovoked VTE is mediated by inflammation of RA and may be considered a spectrum of pan-cardiovascular syndrome.
Collapse
Affiliation(s)
- Gulsen Ozen
- Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Sofia Pedro
- FORWARD, The National Databank for Rheumatic Diseases, Wichita, Kansas, USA
| | - Rebecca Schumacher
- FORWARD, The National Databank for Rheumatic Diseases, Wichita, Kansas, USA
| | - Teresa Simon
- Physicians Research Center, LLC, Toms River, New Jersey, USA
| | - Kaleb Michaud
- Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA .,FORWARD, The National Databank for Rheumatic Diseases, Wichita, Kansas, USA
| |
Collapse
|
6
|
Korkmaz FN, Ozen G, Unal AU, Odabasi A, Can M, Asıcıoglu E, Tuglular S, Direskeneli H. Vitamin D Levels in Patients With Small and Medium Vessel Vasculitis. Reumatol Clin (Engl Ed) 2021; 18:S1699-258X(20)30275-8. [PMID: 33454206 DOI: 10.1016/j.reuma.2020.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 11/11/2020] [Accepted: 11/12/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To determine the prevalence of vitamin D deficiency in patients with small and medium vessel systemic vasculitis. METHODS In this cross-sectional study, 25-hydroxy (OH) vitamin D3 levels were measured in adult patients with systemic small and medium vessel vasculitis including antineutrophil cytoplasmic antibody-associated vasculitis (AAV), cryoglobulinaemic vasculitis (CryV), IgA vasculitis (IgAV) and polyarteritis nodosa (PAN), and age- and sex-matched healthy subjects (HS) and patients with rheumatoid arthritis (RA) as control groups. 25OH vitamin D3 levels<30ng/ml and <20ng/ml were regarded as insufficiency and deficiency, respectively. RESULTS Fifty-seven patients (42 AAV, 2 CryV, 8 IgA vasculitis, 5 PAN) with systemic vasculitis, 101 HS, and 111 RA patients were included. The mean 25OH vitamin D3 level was 21.8±14.2ng/mL in patients with vasculitis, 42.7±27.6ng/mL in HS (p<.001) and 20.1±18.47ng/mL in patients with RA (p=.54). Vitamin D insufficiency and deficiency were significantly higher in patients with systemic vasculitis compared to HS (75.4% vs 33.7%, p<.001; %50 vs 21.8%, p<.001, respectively). Vitamin D status was not different in patients with systemic vasculitis compared to RA. There was a negative correlation between vitamin D status and CRP levels (=-.364, p=.007). The multivariate logistic regression analysis showed that renal involvement was significantly associated with vitamin D deficiency/insufficiency in patients with vasculitis (OR 22.5 [95% CI 1.6-128.9]. CONCLUSION Vitamin D deficiency and insufficiency are more frequent in patients with systemic small and medium vessel vasculitis and RA than HS. Renal involvement is one of the factors associated with vitamin D deficiency/insufficiency in patients with vasculitis.
Collapse
Affiliation(s)
- Fatma Nur Korkmaz
- Ankara University, School of Medicine, Department of Internal Medicine, Division of Endocrinology, Ankara, Turkey.
| | - Gulsen Ozen
- University of Nebraska Medical Center, Department of Internal Medicine, Omaha, NE, USA
| | - Ali Ugur Unal
- Marmara University, School of Medicine, Department of Internal Medicine, Division of Rheumatology, Istanbul, Turkey
| | - Asli Odabasi
- Marmara University, School of Medicine, Department of Internal Medicine, Istanbul, Turkey
| | - Meryem Can
- Medipol Mega Hospitals Complex, Department of Rheumatology, İstanbul, Turkey
| | - Ebru Asıcıoglu
- Marmara University, School of Medicine Hospital, Department of Internal Medicine, Division of Nephrology, Istanbul, Turkey
| | - Serhan Tuglular
- Marmara University, School of Medicine Hospital, Department of Internal Medicine, Division of Nephrology, Istanbul, Turkey
| | - Haner Direskeneli
- Marmara University, School of Medicine, Department of Internal Medicine, Division of Rheumatology, Istanbul, Turkey
| |
Collapse
|
7
|
Abstract
AIM The aim of this study is to examine the health anxiety states and behaviours of athletes during the social isolation period due to COVID-19 pandemic. METHODS 250 elite athletes participated in the study. 154 of the participants were males and 96 were females. Health Anxiety Scale was used to determine the health anxiety states of the participants in the COVID-19 pandemic process. RESULTS Our findings revealed that athletes who were tested for COVID-19 and who thought they had symptoms of the disease had higher levels of health anxiety and athletes who reported a temporary loss in athletic performance had higher disease anxiety. CONCLUSIONS The results of this study showed that the COVID-19 pandemic and social isolation process have some effects on athletes' health anxiety. It will be beneficial to provide psychological support in this period for athletes to have a fast return to competitions and match after the pandemic (Tab. 5, Ref. 24).
Collapse
|
8
|
Ozen G, Michaud K. Response to: ‘Association between proton pump inhibitors therapy and fracture risk in patients with rheumatoid arthritis’ by Lai et al. Ann Rheum Dis 2020; 79:e157. [DOI: 10.1136/annrheumdis-2019-215992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 08/02/2019] [Indexed: 11/04/2022]
|
9
|
Ozen G, Michaud K. Response to: ‘Association of proton pump inhibitors with fracture risk in patients with rheumatoid arthritis’ by Sugiyama. Ann Rheum Dis 2020; 79:e111. [DOI: 10.1136/annrheumdis-2019-215775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 05/25/2019] [Indexed: 11/03/2022]
|
10
|
Ozen G, Pedro S, Michaud K. The Risk of Cardiovascular Events Associated With Disease-modifying Antirheumatic Drugs in Rheumatoid Arthritis. J Rheumatol 2020; 48:648-655. [PMID: 32801134 DOI: 10.3899/jrheum.200265] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2020] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To examine the comparative effects of biologic disease-modifying antirheumatic drugs (bDMARD) and tofacitinib against conventional synthetic DMARD (csDMARD) on incident cardiovascular disease (CVD) in patients with rheumatoid arthritis (RA). METHODS RA patients with ≥ 1 year of participation in the FORWARD study, from 1998 through 2017, were assessed for incident composite CVD events (myocardial infarction, stroke, heart failure, and CVD-related death validated from hospital/death records). DMARD were categorized into 7 mutually exclusive groups: (1) csDMARD-referent; (2) tumor necrosis factor-α inhibitor (TNFi); (3) abatacept (ABA); (4) rituximab; (5) tocilizumab; (6) anakinra; and (7) tofacitinib. Glucocorticoids (GC) were assessed using a weighted cumulative exposure model, which combines information about duration, intensity, and timing of exposure into a summary measure by using the weighted sum of past oral doses (prednisolone equivalent). Cox proportional hazard models were used to adjust for confounders. RESULTS During median (IQR) 4.0 (1.7-8.0) years of follow-up, 1801 CVD events were identified in 18,754 RA patients. The adjusted model showed CVD risk reduction with TNFi (HR 0.81, 95% CI 0.71-0.93) and ABA (HR 0.50, 95% CI 0.30-0.83) compared to csDMARD. While higher GC exposure as weighted cumulative exposure was associated with increased CVD risk (HR 1.15, 95% CI 1.11-1.19), methotrexate (MTX) use was associated with CVD risk reduction [use vs nonuse HR 0.82, 95% CI 0.74-0.90, and high dose (> 15 mg/week) vs low dose (≤ 15 mg/week) HR 0.83, 95% CI 0.70-0.99]. CONCLUSION ABA and TNFi were associated with decreased risk of CVD compared to csDMARD. Minimizing GC use and optimizing MTX dose may improve cardiovascular outcomes in patients with RA.
Collapse
Affiliation(s)
- Gulsen Ozen
- G. Ozen, MD, University of Nebraska Medical Center, Omaha, Nebraska
| | - Sofia Pedro
- S. Pedro, MS, FORWARD, The National Databank for Rheumatic Diseases, Wichita, Kansas
| | - Kaleb Michaud
- K. Michaud, PhD, University of Nebraska Medical Center, Omaha, Nebraska, and FORWARD, The National Databank for Rheumatic Diseases, Wichita, Kansas, USA.
| |
Collapse
|
11
|
Ozen G, Michaud K. Response to: 'Medications associated with fracture risk in patients with rheumatoid arthritis' by Chen et al. Ann Rheum Dis 2019; 80:e141. [PMID: 31601629 DOI: 10.1136/annrheumdis-2019-216293] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 10/01/2019] [Indexed: 11/04/2022]
Affiliation(s)
- Gulsen Ozen
- Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Kaleb Michaud
- Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA .,FORWARD, The National Databank for Rheumatic Diseases, Wichita, Kansas, USA
| |
Collapse
|
12
|
Ozen G, Pedro S, England BR, Mehta B, Wolfe F, Michaud K. Risk of Serious Infection in Patients With Rheumatoid Arthritis Treated With Biologic Versus Nonbiologic Disease-Modifying Antirheumatic Drugs. ACR Open Rheumatol 2019; 1:424-432. [PMID: 31777822 PMCID: PMC6858027 DOI: 10.1002/acr2.11064] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 07/08/2019] [Indexed: 12/19/2022] Open
Abstract
Objective The objective of this study is to examine the risk of serious infections (SIs) associated with biological disease‐modifying antirheumatic drugs (bDMARDs) compared with conventional synthetic disease‐modifying antirheumatic drugs (csDMARDs) in patients with rheumatoid arthritis (RA). Methods We studied patients with RA who initiated bDMARDs or csDMARDs from 2001 to 2016 in FORWARD–The National Databank for Rheumatic Diseases. Disease‐modifying antirheumatic drugs (DMARDs) were categorized into three groups: (1) csDMARDs (bDMARD‐naïve; reference), (2) tumor necrosis factor α inhibitors (TNFis), and (3) non‐TNFi biologics (abatacept, rituximab, tocilizumab, and anakinra). SIs were defined as those requiring intravenous antibiotics or hospitalization or those resulting in death. We calculated the propensity score (PS), which reflected the probability of receiving a specific DMARD group, and estimated the hazard ratio (HR) (with the 95% confidence interval [CI]) for SI from multivariable Cox models, adjusting for PS and time‐varying confounders. Results A total of 694 (5.9%) first SIs were identified in 11 623 patients with RA during 27 552 patient‐years of follow‐up. The SI incidence rate per 1000 patient‐years was 22.4 (95% CI 19.2‐26.1) for csDMARDs, 26.9 (95% CI 24.5‐29.6) for TNFis, and 23.3 (95% CI 19.0‐28.5) for non‐TNFi bDMARDs. Adjusted HRs for SIs were 1.33 (95% CI 1.05‐1.68) for TNFis and 1.48 (95% CI 1.02‐2.16) for non‐TNFi bDMARDs, compared with csDMARDs. The SI risk with non‐TNFi bDMARDs versus TNFis was not different. Other risk factors for SI were older age, higher comorbidity burden (particularly pulmonary disease), higher weighted cumulative prednisone dose, disability and disease activity, and number of prior csDMARD failures. Conclusion TNFis and non‐TNFi bDMARDs were associated with an increased SI risk compared with csDMARDs in RA, even after accounting for risk‐associated patient characteristics.
Collapse
Affiliation(s)
| | - Sofia Pedro
- FORWARD-The National Databank for Rheumatic Diseases Wichita Kansas
| | - Bryant R England
- University of Nebraska Medical Center and VA Nebraska-Western Iowa Health Care System Omaha
| | - Bella Mehta
- Hospital for Special Surgery New York New York
| | - Frederick Wolfe
- FORWARD-The National Databank for Rheumatic Diseases Wichita Kansas
| | - Kaleb Michaud
- University of Nebraska Medical Center, Omaha, and FORWARD-The National Databank for Rheumatic Diseases Wichita Kansas
| |
Collapse
|
13
|
Mehta B, Pedro S, Ozen G, Kalil A, Wolfe F, Mikuls T, Michaud K. Serious infection risk in rheumatoid arthritis compared with non-inflammatory rheumatic and musculoskeletal diseases: a US national cohort study. RMD Open 2019; 5:e000935. [PMID: 31245055 PMCID: PMC6560658 DOI: 10.1136/rmdopen-2019-000935] [Citation(s) in RCA: 82] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 04/23/2019] [Accepted: 05/15/2019] [Indexed: 11/04/2022] Open
Abstract
Objectives To identify serious infection (SI) risk by aetiology and site in patients with rheumatoid arthritis (RA) compared with those with non-inflammatory rheumatic and musculoskeletal diseases (NIRMD). Methods Patients participating in FORWARD from 2001 to 2016 were assessed for SIs; defined by infections requiring hospitalisation, intravenous antibiotics or followed by death. SIs were categorised by aetiology and site. SI risk was assessed through Cox proportional hazards models. Best models were selected using machine learning Least Absolute Shrinkage and Selection Operator (LASSO) methodology. Results Among 20 361 patients with RA and 6176 patients with NIRMD, 1600 and 276 first SIs were identified, respectively. Incidence of SIs was higher in RA compared with NIRMD (IRR = 1.5; 95% CI 1.2 to 1.5). The risk persisted after adjusting using the LASSO model (HR 1.7; 95% CI 1.5 to 1.8), but attenuated when additionally adjusted for glucocorticoid use (HR 1.3; 95% CI 1.2 to 1.5). SI risk was significantly higher in RA versus NIRMD for bacterial infections as well as for respiratory, skin, bone, joint, bloodstream infections and sepsis irrespective of glucocorticoid use. Compared with NIRMD, SI risk was significantly increased in patients with RA who were in moderate and high disease activity but was similar to those in low disease activity/remission (p trend < 0.001). Conclusions The risk of all SIs, particularly bacterial, respiratory, bloodstream, sepsis, skin, bone and joint infections are significantly increased in patients with RA compared with patients with NIRMD. This infection risk appears to be greatest in those with higher RA disease activity.
Collapse
Affiliation(s)
- Bella Mehta
- Department of Medicine, Hospital for Special Surgery, New York, New York, USA
| | - Sofia Pedro
- Forward, The National Databank for Rheumatic Diseases, Wichita, Kansas, USA
| | - Gulsen Ozen
- Department of Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Andre Kalil
- Department of Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Frederick Wolfe
- Forward, The National Databank for Rheumatic Diseases, Wichita, Kansas, USA
| | - Ted Mikuls
- Department of Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Kaleb Michaud
- Forward, The National Databank for Rheumatic Diseases, Wichita, Kansas, USA.,Department of Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
| |
Collapse
|
14
|
Ozen G, Pedro S, Schumacher R, Simon TA, Michaud K. Safety of abatacept compared with other biologic and conventional synthetic disease-modifying antirheumatic drugs in patients with rheumatoid arthritis: data from an observational study. Arthritis Res Ther 2019; 21:141. [PMID: 31174592 PMCID: PMC6555014 DOI: 10.1186/s13075-019-1921-z] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 05/17/2019] [Indexed: 02/06/2023] Open
Abstract
Background To assess the risks of malignancies, infections and autoimmune diseases in patients with rheumatoid arthritis (RA) treated with abatacept compared with other biologic (b) disease-modifying antirheumatic drugs (DMARDs) or conventional synthetic (cs)DMARDs, in a US-wide observational RA cohort Methods Data were reviewed from patients (≥ 18 years) with RA who were registered with FORWARD, the National Databank for Rheumatic Diseases, and who initiated abatacept, other bDMARDs or csDMARDs between 2005 and 2015. Patients who switched treatment during the study could be allocated to more than one group. The incidence rates (IRs) by treatment were calculated for malignancies, hospitalized infections and autoimmune diseases identified by six monthly questionnaires and medical records. The hazard ratios (HRs) (95% confidence intervals [CIs]) for all outcomes with abatacept compared with other bDMARDs or csDMARDs were determined using marginal structural models adjusted for clinical confounders. Results In the study sample, 1496 initiated abatacept, 3490 initiated another bDMARD and 1520 initiated a csDMARD. The risk of malignancies with abatacept was not statistically significant versus other bDMARDs (HR [95% CI)] 1.89 [0.93, 3.84]) or versus csDMARDs (HR [95% CI] 0.93 [0.20, 4.27]). Patients receiving abatacept versus other bDMARDs were at a lower risk of hospitalized infections (HR [95% CI] 0.37 [0.18, 0.75]); the risk versus csDMARDs was lower with wide CIs (HR [95% CI] 0.31 [0.09, 1.05]). The relative risks for psoriasis were similar between treatment groups (HR [95% CI] 1.46 [0.76, 2.81] and HR [95% CI] 2.05 [0.59, 7.16] for abatacept versus other bDMARDs and versus csDMARDS, respectively). The IR (95% CI) of severe infusion/injection reactions was lower with abatacept compared with other bDMARDs (1.57 [1.11, 2.17] vs 2.31 [1.87, 2.82] per 100 patient-years, respectively). Conclusions In this analysis, abatacept was well tolerated and did not result in an overall increased risk of malignancies, infections or autoimmune diseases compared with other bDMARDs or csDMARDs. Electronic supplementary material The online version of this article (10.1186/s13075-019-1921-z) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Gulsen Ozen
- University of Nebraska Medical Center, Omaha, NE, USA
| | - Sofia Pedro
- FORWARD, The National Databank for Rheumatic Diseases, Wichita, KS, USA
| | | | | | - Kaleb Michaud
- University of Nebraska Medical Center, Omaha, NE, USA. .,FORWARD, The National Databank for Rheumatic Diseases, Wichita, KS, USA.
| |
Collapse
|
15
|
Ozen G, Pedro S, Wolfe F, Michaud K. Medications associated with fracture risk in patients with rheumatoid arthritis. Ann Rheum Dis 2019; 78:1041-1047. [PMID: 31092411 DOI: 10.1136/annrheumdis-2019-215328] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 04/22/2019] [Accepted: 04/23/2019] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To examine the fracture risk with use of disease-modifying antirheumatic drugs (DMARDs), statins, proton pump inhibitors (PPIs), opioids, non-opioid analgesics and psychotropic medications in a US-wide observational rheumatoid arthritis (RA) cohort. METHODS Patients with RA without prior fracture from 2001 through 2017 in FORWARD, a longitudinal observational registry, were assessed for osteoporosis-related site fractures (vertebra, hip, forearm and humerus). DMARD exposure was assessed in four mutually exclusive groups: (1) methotrexate monotherapy-reference, (2) tumour necrosis factor-α inhibitors (TNFi), (3) non-TNFi biologics and (4) others. Non-DMARDs and glucocorticoids were classified as current/ever use and based on treatment duration. Fracture Risk Assessment Tool (FRAX) scores estimating for 10-year major osteoporotic fractures were calculated. Cox proportional hazard models stratified by FRAX were used to adjust for confounders. RESULTS During median (IQR) 3.0 (1.5-6.0) years of follow-up in 11 412 patients, 914 fractures were observed. The adjusted models showed a significant fracture risk increase with use of any dose glucocorticoids ≥3 months (HR (95% CI) for <7.5 mg/day 1.26 (1.07 to 1.48) and for ≥7.5 mg/day 1.57 (1.27 to 1.94)), opioids (for weak: 1.37 (1.18 to 1.59); strong: 1.53 (1.24 to 1.88)) and selective serotonin reuptake inhibitors (SSRIs) (1.37 (1.15 to 1.63)). Fracture risk with opioids increased within 1 month of use (1.66 (1.36 to 2.04)) and with SSRIs >3 months of use (1.25 (1.01 to 1.55)). Statins (0.77 (0.62 to 0.96)) and TNFi (0.72 (0.54 to 0.97)) were associated with reduction in vertebral fracture risk only. PPIs and other psychotropic medications were not associated with increased fracture risk. CONCLUSION Use of opioids, SSRIs and glucocorticoids were associated with increased risk of any fracture in patients with RA, whereas statins and TNFi were associated with decreased vertebral fractures.
Collapse
Affiliation(s)
- Gulsen Ozen
- University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Sofia Pedro
- Forward, The National Databank for Rheumatic Diseases, Wichita, Kansas, USA
| | - Frederick Wolfe
- Forward, The National Databank for Rheumatic Diseases, Wichita, Kansas, USA
| | - Kaleb Michaud
- University of Nebraska Medical Center, Omaha, Nebraska, USA .,Forward, The National Databank for Rheumatic Diseases, Wichita, Kansas, USA
| |
Collapse
|
16
|
Yilmaz-Oner S, Ilhan B, Can M, Alibaz-Oner F, Polat-Korkmaz O, Ozen G, Mumcu G, Kremers HM, Tuglular S, Direskeneli H. Fatigue in systemic lupus erythematosus : Association with disease activity, quality of life and psychosocial factors. Z Rheumatol 2019; 76:913-919. [PMID: 27600110 DOI: 10.1007/s00393-016-0185-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE The aim of the study was to determine which disease-related factors and non-disease features can explain the presence of systemic lupus erythematosus (SLE)-related fatigue in Turkish patients. METHODS This cross-sectional study was carried out with 99 SLE patients and 71 healthy controls. To assess fatigue and health-related quality of life (HRQoL) the participants were asked to complete two questionnaires: the short form-36 health survey (SF-36) and the multidimensional assessment of fatigue (MAF) scale. Anxiety and depression of participants were assessed by the hospital anxiety and depression scale (HADS). RESULTS A total of 99 patients (female/male 95/4) and 71 controls (female/male 40/31) were studied. The mean age and standard deviation (±SD) of patients and controls were 43.3 ± 12.2 years and 43.2 ± 12.1 years, respectively. The mean (SD) disease duration was 7.8 ± 5.3 years and median SLE disease activity index (SLEDAI) score was 0 (range = 0-16). The level of fatigue was higher in patients compared to controls with mean MAF scores of 24.7 ± 12.2 and 12.8 ± 9.9 (p < 0.001), respectively. The HADS-D and HADS-A scores were also significantly higher in SLE patients (6.6 ± 4.3 vs. 3.6 ± 2.9, p < 0.001 and 7.2 ± 4 vs. 4.9 ± 4, p = 0.007, respectively). There were no significant associations between the MAF and SLEDAI scores (r = 0.05, p = 0.63) but MAF scores positively correlated with age, HADS-A and HADS-D scores and negatively correlated with physical component summary (PCS), mental component summary (MCS) and each domain of SF-36 except role emotional in SLE patients. CONCLUSION Fatigue is an important factor influencing patient daily life independent from disease activity in our study. The SLE patients with severe fatigue should also be assessed for other possible underlying causes such as anxiety, depression and poor quality of life.
Collapse
Affiliation(s)
- S Yilmaz-Oner
- School of Medicine, Department of Rheumatology, Marmara University, 34890, Pendik Istanbul, Turkey.
| | - B Ilhan
- School of Medicine, Marmara University, Istanbul, Turkey
| | - M Can
- School of Medicine, Department of Rheumatology, Marmara University, 34890, Pendik Istanbul, Turkey
| | - F Alibaz-Oner
- School of Medicine, Department of Rheumatology, Marmara University, 34890, Pendik Istanbul, Turkey
| | | | - G Ozen
- School of Medicine, Department of Rheumatology, Marmara University, 34890, Pendik Istanbul, Turkey
| | - G Mumcu
- Faculty of Health Sciences, Department of Health Management, Marmara University, Istanbul, Turkey
| | - H M Kremers
- College of Medicine, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - S Tuglular
- School of Medicine, Department of Nephrology, Marmara University, Istanbul, Turkey
| | - H Direskeneli
- School of Medicine, Department of Rheumatology, Marmara University, 34890, Pendik Istanbul, Turkey
| |
Collapse
|
17
|
Ergun T, Yazici V, Yavuz D, Seckin-Gencosmanoglu D, Ozen G, Salman A, Direskeneli H, Inanc N. Advanced Glycation End Products, a Potential Link between Psoriasis and Cardiovascular Disease: A Case-control Study. Indian J Dermatol 2019; 64:201-206. [PMID: 31148858 PMCID: PMC6537697 DOI: 10.4103/ijd.ijd_396_18] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Context Advanced glycation end products (AGEs) promote oxidative stress and inflammation by altering structure and function of proteins. They are excessively produced mainly in hyperglycemia, chronic inflammation and are involved in the development of atherosclerosis and cardiovascular disease. Aims The aim of this study was to investigate whether skin AGEs levels were increased and had relation to premature atherosclerosis in patients with psoriasis. Subjects and Methods Fifty-two psoriasis patients and 20 healthy controls (HC) were included. AGEs were determined by skin autofluorescence (SAF) analysis. High-sensitive C-reactive protein (hsCRP) and carotid intima-media thickness (CIMT) were also investigated. Physical activity and dietary patterns were determined. Statistical Analysis Used Fisher's exact test, two-sample t-tests, Mann-Whitney-U test, Pearson correlation, Spearman correlation, and Wilcoxon test. Results SAFs were increased in psoriasis patients (1.8 arbitrary units [AUs]) compared to that in HC (1.6 AUs) (P = 0.057). Median CIMT values of HC and psoriasis groups were 0.43 (0.28-0.79), and 0.59 (0.44-0.98) respectively and the differences were significant (P = 0.001); hsCRP levels were not different between groups. Conclusions Skin AGE accumulation was found to have a correlation with CIMT in psoriasis patients providing evidence for the role of AGEs in premature atherosclerosis.
Collapse
Affiliation(s)
- Tulin Ergun
- Department of Dermatology, Marmara University School of Medicine, Istanbul, Turkey
| | - Vildan Yazici
- Department of Dermatology, Gebze Medical Park Hospital, Kocaeli, Turkey
| | - Dilek Yavuz
- Department of Endocrinology, Marmara University School of Medicine, Istanbul, Turkey
| | | | - Gulsen Ozen
- Department of Rheumatology, Marmara University School of Medicine, Istanbul, Turkey
| | - Andac Salman
- Department of Dermatology, Marmara University School of Medicine, Istanbul, Turkey
| | - Haner Direskeneli
- Department of Rheumatology, Marmara University School of Medicine, Istanbul, Turkey
| | - Nevsun Inanc
- Department of Rheumatology, Marmara University School of Medicine, Istanbul, Turkey
| |
Collapse
|
18
|
Kucukkomurcu E, Unal AU, Esen F, Ozen G, Direskeneli H, Kazokoglu H. Ocular Posterior Segment Involvement in Patients with Antiphospholipid Syndrome and Systemic Lupus Erythematosus. Ocul Immunol Inflamm 2018; 28:86-91. [PMID: 30556792 DOI: 10.1080/09273948.2018.1552759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Purpose: To describe posterior segment findings of antiphospholipid syndrome (APS) and compare them with systemic lupus erythematosus (SLE).Methods: A total of 11 patients with primary APS, 29 secondary APS patients, and 29 SLE patients without APS were included. All patients were referred from rheumatology clinic for detailed ophthalmologic examination. When patients had suspicious lesions, fundus fluorescein angiography was performed (n = 56).Results: The most common retinal examination finding was peripheral venous tortuosity (17.5%) in APS, which was not observed in SLE group. Common FFA findings were pigment epithelial window defects (10%) and vascular filling delays (7.5%) in APS, which were observed in 27.5% and 3.5% of patients with SLE consecutively.Conclusion: Venous tortuosity was significantly more in patients with APS. There was no significant difference for other ocular findings between the groups. Ocular complication rate was lower compared to earlier reports, probably due to better management of disease activity with current treatment protocols.
Collapse
Affiliation(s)
- Elvan Kucukkomurcu
- Department of Ophthalmology, Hitit University School of Medicine, Corum, Turkey
| | - Ali Ugur Unal
- Division of Rheumatology, Marmara University School of Medicine, Istanbul, Turkey
| | - Fehim Esen
- Department of Ophthalmology, Istanbul Medeniyet University School of Medicine, Istanbul, Turkey
| | - Gulsen Ozen
- Division of Rheumatology, Marmara University School of Medicine, Istanbul, Turkey
| | - Haner Direskeneli
- Division of Rheumatology, Marmara University School of Medicine, Istanbul, Turkey
| | - Haluk Kazokoglu
- Department of Ophthalmology, Marmara University School of Medicine, Istanbul, Turkey
| |
Collapse
|
19
|
Ozen G, Kamen DL, Mikuls TR, England BR, Wolfe F, Michaud K. Trends and Determinants of Osteoporosis Treatment and Screening in Patients With Rheumatoid Arthritis Compared to Osteoarthritis. Arthritis Care Res (Hoboken) 2018; 70:713-723. [PMID: 28771973 PMCID: PMC5797515 DOI: 10.1002/acr.23331] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 07/25/2017] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To profile osteoporosis (OP) care in patients with rheumatoid arthritis (RA) over the past decade. METHODS Patients with RA or osteoarthritis (OA) were followed from 2003 through 2014. OP care was defined as receipt of OP treatment (with the exception of calcium/vitamin D) or screening (OPTS). Adjusted trends over followup, and the factors associated with OP care, were examined using multivariable Cox proportional hazards. RESULTS OPTS was reported in 67.4% of 11,669 RA patients and in 64.6% of 2,829 OA patients during a median (interquartile range) 5.5 (2-9) years of followup. In patients for whom treatment was recommended by the 2010 American College of Rheumatology (ACR) glucocorticoid-induced OP (GIOP) guidelines (48.4% of RA patients and 17.6% of OA patients), approximately 55% overall reported OP medication use. RA patients were not more likely to undergo OPTS compared to OA patients (hazard ratio 1.04 [95% confidence interval 0.94-1.15]). Adjusted models showed a stable trend for OPTS between 2004 and 2008 compared to 2003, with a significant downward trend after 2008 in both RA and OA patients. Factors associated with receipt of OP care in RA patients were older age, postmenopausal state, prior fragility fracture or diagnosis of OP, any duration of glucocorticoid treatment, and use of biologic agents. CONCLUSION Approximately half of RA patients for whom treatment was indicated never received an OP medication. OP care in RA patients was not better than in OA patients, and the relative risk of the application of this care has been decreasing in RA and OA patients since 2008 without improvement after the release of the 2010 ACR GIOP guideline.
Collapse
Affiliation(s)
- Gulsen Ozen
- University of Nebraska Medical Center, Omaha, NE
- Marmara University, Faculty of Medicine, Istanbul, Turkey
| | - Diane L Kamen
- Medical University of South Carolina, Charleston, SC
| | - Ted R Mikuls
- University of Nebraska Medical Center, Omaha, NE
- Veterans Affairs (VA) Nebraska-Western Iowa Health Care System, Omaha, NE
| | - Bryant R England
- University of Nebraska Medical Center, Omaha, NE
- Veterans Affairs (VA) Nebraska-Western Iowa Health Care System, Omaha, NE
| | | | - Kaleb Michaud
- University of Nebraska Medical Center, Omaha, NE
- National Data Bank for Rheumatic Diseases, Wichita, KS
| |
Collapse
|
20
|
Abstract
Background Systemic sclerosis can affect peripheral nerves, but the extent and the nature of this involvement are not well defined. The aim of this study is to compare the sonoelastrographic measurements of median nerves in systemic sclerosis (SSC), idiopathic carpal tunnel syndrome (CTS) and healthy individuals. Methods The clinical, electrophysiological and ultrasonographic assessments were done. Patients with SSC and CTS were assessed with nerve conduction studies. The measurements of cross sectional areas (CSA) were performed at psiform and forearm level from axial US images. The elastic ratio is the ratio of strain distribution in two selected region of interests (ROI) done via comparing the median nerve to flexor digitorum superfcialis tendon. The ROIs were fixed to 2 mm. Results The study was completed with 47 hands of 24 patients with SSC, 53 hands of 27 patients with CTS and 38 hands of health controls. The CSA of CTS group was significantly higher than systemic sclerosis and control groups. The elastic ratio at psiform level and forearm levels of systemic sclerosis group were significantly higher than the CTS and control groups. Conclusion Median nerves lose the elasticity while the CSA’s are in the normal range in patients with SSC. These results suggested that the increased peripheral nerve involvement in SSC is about the increased stiffness of the nerves.
Collapse
Affiliation(s)
- Ilker Yagci
- Marmara University Hospital, Physical Medicine and Rehabilitation Department, Istanbul, Turkey
| | - Ozge Kenis-Coskun
- Kartal Research and Training Hospital, Physical Medicine and Rehabilitation Department, Şemsi Denizer Caddesi, 34865 Kartal, Istanbul, Turkey.
| | - Tugba Ozsoy
- Marmara University Hospital, Physical Medicine and Rehabilitation Department, Istanbul, Turkey
| | - Gulsen Ozen
- Marmara University Hospital, Rheumatology Department, Istanbul, Turkey
| | - Haner Direskeneli
- Marmara University Hospital, Rheumatology Department, Istanbul, Turkey
| |
Collapse
|
21
|
Deniz R, Tulunay-Virlan A, Ture Ozdemir F, Unal AU, Ozen G, Alibaz-Oner F, Aydin-Tatli I, Mumcu G, Ergun T, Direskeneli H. Th17-Inducing Conditions Lead to in vitro Activation of Both Th17 and Th1 Responses in Behcet's Disease. Immunol Invest 2017; 46:518-525. [PMID: 28414558 DOI: 10.1080/08820139.2017.1306865] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVES 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: 38.5 ± 9.8 years) with BD, and 25 healthy controls (HC) (age: 39.1 ± 9.3 years), were cultured in Th17-inducing conditions (IL-6, Phytohemagglutinin (PHA), IL-1β, and IL-23) for 6 days. Cultured cells were stained with CD4, CD8, CD3, TCR gamma/delta, CD19, interferon-γ (IFN-γ), and IL-17 antibodies to determine the intracellular cytokine secretion by flow cytometry. RESULTS IL-17 expression by CD8+ and γδ+ 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-γ by CD4+, CD8+, and γδ+ 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-γ in BD. More prominent IL-17 and IFN-γ 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.
Collapse
Affiliation(s)
- Rabia Deniz
- a Department of Internal Medicine, School of Medicine , Marmara University , Istanbul , Turkey
| | - Aysın Tulunay-Virlan
- b Department of Immunology, School of Medicine , Marmara University , Istanbul , Turkey
| | - Filiz Ture Ozdemir
- b Department of Immunology, School of Medicine , Marmara University , Istanbul , Turkey
| | - Ali Ugur Unal
- c Division of Rheumatology, School of Medicine , Marmara University , Istanbul , Turkey
| | - Gulsen Ozen
- c Division of Rheumatology, School of Medicine , Marmara University , Istanbul , Turkey
| | - Fatma Alibaz-Oner
- c Division of Rheumatology, School of Medicine , Marmara University , Istanbul , Turkey
| | - Imren Aydin-Tatli
- b Department of Immunology, School of Medicine , Marmara University , Istanbul , Turkey
| | - Gonca Mumcu
- d Faculty of Health Science, Department of Health Informatics and Technologies, School of Medicine , Marmara University , Istanbul , Turkey
| | - Tulin Ergun
- e Department of Dermatology, School of Medicine , Marmara University , Istanbul , Turkey
| | - Haner Direskeneli
- c Division of Rheumatology, School of Medicine , Marmara University , Istanbul , Turkey
| |
Collapse
|
22
|
Ozen G, Deniz R, Eren F, Erzik C, Unal AU, Yavuz S, Aydin SZ, Inanc N, Direskeneli H, Atagunduz P. Association of ERAP1, IL23R and PTGER4 Polymorphisms with Radiographic Severity of Ankylosing Spondylitis. Open Rheumatol J 2017; 11:1-9. [PMID: 28400866 PMCID: PMC5366379 DOI: 10.2174/1874312901711010001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 12/14/2016] [Accepted: 01/04/2017] [Indexed: 11/22/2022] Open
Abstract
Background: Radiographic severity of ankylosing spondylitis (AS) shows such great variance that some patients never develop syndesmophytes throughout the entire disease span, whereas some develop bamboo spine relatively early. Objective: To study the association between ERAP1, IL23R and PTGER4 single nucleotide polymorphisms (SNPs) and radiographic severity in AS patients. Methods: rs27044 and rs30187 (ERAP1), rs11209032 (IL23R) and rs10440635 (PTGER4) SNPs were genotyped in 235 AS patients fulfilling the modified New York criteria. Patients were classified as mild- and severe-AS according to modified Stoke AS spinal score (mSASSS). Mild-AS is defined as having mSASSS of “0” following at least 10 years of disease duration. Severe-AS is defined as having mSASSS of >20 (patients with mild vertebral changes (i.e. squaring or erosions) were omitted for clear stratification) regardless of disease duration. Results: The genotype distributions and allele frequencies of ERAP1 rs27044 and rs30187, IL23R rs11209032 and PTGER4 rs10440635 SNPs were similar in mild- (n=171, mSASSS=0, 55.6% HLA-B27 positive) and severe-AS patients (n=64, mSASSS=48.5±17.8, 73.4% HLA-B27 positive). After adjustment for clinical differences between groups (gender, disease duration, HLA-B27 and smoking status) by logistic regression analysis, none of the alleles in the investigated SNPs were found to be associated with radiographic severity of AS. Conclusion: In radiographically well-categorized AS patients, ERAP1 rs27044 and rs30187, IL23R rs11209032 and PTGER4 rs10440635 SNPs are not found to be associated with radiographic severity of AS.
Collapse
Affiliation(s)
- Gulsen Ozen
- Department of Rheumatology, Faculty of Medicine, Marmara University, Istanbul, Turkey
| | - Rabia Deniz
- Department of Internal Medicine, Faculty of Medicine, Marmara University, Istanbul, Turkey
| | - Fatih Eren
- Department of Medical Biology, Faculty of Medicine, Marmara University, Istanbul, Turkey
| | - Can Erzik
- Department of Medical Biology, Faculty of Medicine, Marmara University, Istanbul, Turkey
| | - Ali Ugur Unal
- Department of Rheumatology, Faculty of Medicine, Marmara University, Istanbul, Turkey
| | - Sule Yavuz
- Department of Rheumatology, Faculty of Medicine, Bilim University, Istanbul, Turkey
| | - Sibel Zehra Aydin
- Department of Rheumatology, School of Medicine, Ottawa University, Ottawa, Ontario, Canada
| | - Nevsun Inanc
- Department of Rheumatology, Faculty of Medicine, Marmara University, Istanbul, Turkey
| | - Haner Direskeneli
- Department of Rheumatology, Faculty of Medicine, Marmara University, Istanbul, Turkey
| | - Pamir Atagunduz
- Department of Rheumatology, Faculty of Medicine, Marmara University, Istanbul, Turkey
| |
Collapse
|
23
|
Ozen G, Pedro S, Michaud K. Response to: ‘Statin therapy now more common than steroids in clinical practice’ by Pareek and Chankurdar. Ann Rheum Dis 2016; 76:e19. [DOI: 10.1136/annrheumdis-2016-210906] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Accepted: 12/10/2016] [Indexed: 12/11/2022]
|
24
|
Ozen G, Pedro S, Holmqvist ME, Avery M, Wolfe F, Michaud K. Risk of diabetes mellitus associated with disease-modifying antirheumatic drugs and statins in rheumatoid arthritis. Ann Rheum Dis 2016; 76:848-854. [PMID: 27836820 DOI: 10.1136/annrheumdis-2016-209954] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 10/19/2016] [Accepted: 10/21/2016] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To investigate the rate of incident diabetes mellitus (DM) in patients with rheumatoid arthritis (RA) and the impact of disease-modifying antirheumatic drug (DMARD) and statin treatments. METHODS We studied patients with RA and ≥1 year participation in the National Data Bank for Rheumatic Diseases without baseline DM from 2000 through 2014. DM was determined by self-report or initiating DM medication. DMARDs were categorised into four mutually exclusive groups: (1) methotrexate monotherapy (reference); (2) any abatacept with or without synthetic DMARDs (3) any other DMARDs with methotrexate; (4) all other DMARDs without methotrexate; along with separate statin, glucocorticoid and hydroxychloroquine (yes/no) variables. Time-varying Cox proportional hazard models were used to adjust for age, sex, socioeconomic status, comorbidities, body mass index and RA severity measures. RESULTS During a median (IQR) 4.6 (2.5-8.8) years of follow-up in 13 669 patients with RA, 1139 incident DM cases were observed. The standardised incidence ratio (95% CI) of DM in patients with RA (1.37, (1.29 to 1.45)) was increased compared with US adult population. Adjusted HR (95% CI) for DM were 0.67 (0.57 to 0.80) for hydroxychloroquine, 0.52 (0.31 to 0.89) for abatacept (compared with methotrexate monotherapy), 1.31 (1.15 to 1.49) for glucocorticoids and 1.56 (1.36 to 1.78) for statins. Other synthetic/biological DMARDs were not associated with any risk change. Concomitant use of glucocorticoids did not alter DM risk reduction with hydroxychloroquine (HR 0.69 (0.51 to 0.93)). CONCLUSIONS In RA, incidence of DM is increased. Hydroxychloroquine and abatacept were associated with decreased risk of DM, and glucocorticoids and statins with increased risk.
Collapse
Affiliation(s)
- Gulsen Ozen
- University of Nebraska Medical Center, Omaha, Nebraska, USA.,Faculty of Medicine, Marmara University, Istanbul, Turkey
| | - Sofia Pedro
- National Data Bank for Rheumatic Diseases, Wichita, Kansas, USA
| | - Marie E Holmqvist
- Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | | | - Frederick Wolfe
- National Data Bank for Rheumatic Diseases, Wichita, Kansas, USA
| | - Kaleb Michaud
- University of Nebraska Medical Center, Omaha, Nebraska, USA.,National Data Bank for Rheumatic Diseases, Wichita, Kansas, USA
| |
Collapse
|
25
|
Korkmaz FN, Ozen G, Ünal AU, Kahraman Koytak P, Tuncer N, Direskeneli H. Severe neuro-Behcet's disease treated with a combination of immunosuppressives and a TNF-inhibitor. Acta Reumatol Port 2016; 41:367-371. [PMID: 27750273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Abstract/ Resumo Behcet's disease (BD) is a multisystem inflammatory disorder characterized by recurrent oral and genital ulcers, skin lesions and uveitis. The nervous system involvement of BD, neuro-Behcet's disease (NBD), is one of the important causes of mortality of the disease. Herein, we present a 29-year-old male with parenchymal NBD who has progressed rapidly and was managed with an uncommon aggressive immunosuppresive combination therapy. The patient first presented six years ago with vertigo and difficulty in talking and walking. On examination, he had oral ulcers, acneiform lesions on the torso, genital ulcer scar, dysartria, and ataxia. Along with the magnetic resonance imaging (MRI) findings, the patient was diagnosed as NBD. After pulse methylprednisolone (1g/day, 3 days) and 8 courses of 1g/month iv cylophosphamide therapy, he was put on azathioprine and oral methlyprednisolone. On the 4th year of the maintenance therapy, he was admitted with NBD relapse which was treated with 3 days of iv 1g pulse methlyprednisolone. One year after the last relapse, the patient voluntarily stopped medications and presented with global aphasia, right hemihypoesthesia and quadriparesis. MRI findings were suggestive of NBD relapse. After exclusion of infection, pulse methylprednisolone was started but no improvement was observed. Considering the severity of the NBD, the patient was put on methylprednisolone (1mg/kg/day), iv cylophosphamide (1g) and adalimumab 40 mg/14 days subcutaneously with appropriate tuberculosis prophylaxis. Neurological examination and MRI findings after 4 weeks showed dramatic improvement however patient developed pulmonary tuberculosis. Methylprednisolone dose was decreased (0.5mg/kg/day) and quadruple antituberculosis therapy was started. Patient was discharged with 5/5 muscle strength in extremities without any respiratory symptoms 2 months after first presentation. Prompt introduction of immunosuppressive therapy is crucial in NBD. Although combination of TNF inhibitors and cyclophoshamide is a rare therapeutic approach, it may be life-saving. However a higher awareness is required for opportunistic infections.
Collapse
|
26
|
Ozen G, Inanc N, Unal AU, Korkmaz F, Sunbul M, Ozmen M, Akar S, Deniz R, Donmez S, Pamuk ON, Atagunduz P, Tigen K, Direskeneli H. Subclinical Atherosclerosis in Systemic Sclerosis: Not Less Frequent Than Rheumatoid Arthritis and Not Detected With Cardiovascular Risk Indices. Arthritis Care Res (Hoboken) 2016; 68:1538-46. [DOI: 10.1002/acr.22852] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Revised: 12/09/2015] [Accepted: 01/26/2016] [Indexed: 01/09/2023]
Affiliation(s)
- Gulsen Ozen
- Marmara University Faculty of Medicine; Istanbul Turkey
| | - Nevsun Inanc
- Marmara University Faculty of Medicine; Istanbul Turkey
| | - Ali U. Unal
- Marmara University Faculty of Medicine; Istanbul Turkey
| | | | - Murat Sunbul
- Marmara University Faculty of Medicine; Istanbul Turkey
| | - Mustafa Ozmen
- Katip Celebi University Faculty of Medicine; Izmir Turkey
| | - Servet Akar
- Katip Celebi University Faculty of Medicine; Izmir Turkey
| | - Rabia Deniz
- Marmara University Faculty of Medicine; Istanbul Turkey
| | - Salim Donmez
- Trakya University Faculty of Medicine; Edirne Turkey
| | - Omer N. Pamuk
- Trakya University Faculty of Medicine; Edirne Turkey
| | | | - Kursat Tigen
- Marmara University Faculty of Medicine; Istanbul Turkey
| | | |
Collapse
|
27
|
Ozen G, Unal A, Topcu A, Atagunduz P, Direskeneli H, Inanc N. THU0049 Is Patient Global Assessment in Boolean-Based Remission in Rheumatoid Arthritis Really Required Instead of Physician Global Assessment? A Comparative Study with Ultrasound. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.1540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
28
|
Ozen G, Unal A, Topcu A, Atagunduz P, Direskeneli H, Inanc N. FRI0531 Differences in Ultrasonographic Disease Activity in Rheumatoid Arthritis Patients Who Are in Clinical Remission According To Different Remission Criteria. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.1542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
29
|
Yagci I, Kenis Coskun O, Ozsoy T, Ozen G, Direskeneli H. AB0602 Increased Stiffness of Median Nerve in Systemic Sclerosis:. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.2876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
30
|
Tascilar K, Hatemi G, Inanc N, Simsek I, Swearingen C, Cinar M, Ugurlu S, Yilmaz S, Ozen G, Pay S, Direskeneli H, Yazici Y. SAT0593 Discrepancy between Patients and Physicians on Global Disease Assessment of RA and Its Determinants: An Analysis from The TRAV Cohort. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.5857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
31
|
Ozen G, Pedro S, Holmqvist M, Michaud K. THU0082 Medication Impact on The Risk of Incident Diabetes Mellitus in Patients with Rheumatoid Arthritis: Hydroxychloroquine and Abatacept Protect while Glucocorticoids and Statins Worsen: Table 1. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.4201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
32
|
Temiz F, Saganak M, Enginar N, Ozen G, Unal A, Sahinkaya Y, Direskeneli H. AB0622 Assessment of Ouality of Life in Systemic Sclerosis Patient with Translation, Cross-Cultural Adaptation, and Validation of The Systemic Sclerosis Questionnaire (SySQ) into The Turkish Language. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.2011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
33
|
Unal A, Yildirim H, Cikikci C, Ozen G, Inanc N, Atagunduz P, Ergun T, Direskeneli H. SAT0341 Assessment of Damage in Behcet's Disease: Do We Need A Specific Damage Index? Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.4777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
34
|
Korkmaz F, Ozen G, Unal A, Can M, Tuglular S, Direskeneli H. AB0530 25-Hydroxyvitamin D3 Deficiency: Prevalance and Its Impact on Disease Activity in Small-Medium Vessel Vasculitis. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.2768] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
35
|
Kucukkomurcu E, Unal A, Esen F, Ozen G, Diresekeneli H, Kazokoglu H. AB0445 Ocular Posterior Segment Findings in Antiphospholipid Syndrome. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.4991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
36
|
Inanc N, Ozen G, Aydin SZ, Kasapoglu-Gunal E, Direskeneli H. Ultrasonographic Assessment of Fifth Metatarsophalangeal Joint Erosion in Rheumatoid Arthritis: Which Aspect Is Better? Ultrasound Med Biol 2016; 42:864-869. [PMID: 26742892 DOI: 10.1016/j.ultrasmedbio.2015.11.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2015] [Revised: 11/23/2015] [Accepted: 11/25/2015] [Indexed: 06/05/2023]
Abstract
In this study, the best ultrasound (US) aspect for detection of fifth metatarsophalangeal (MTP) joint erosions, the most frequently eroded joint, in rheumatoid arthritis (RA) patients is investigated. Forty-eight RA patients (F/M = 35/13, mean age and disease durations 50.3 ± 11.8 and 7.9 ± 6.9 y, respectively) were evaluated by B-mode US for erosion. Images were obtained from the dorsal, lateral and plantar aspect of the fifth MTP joint, in longitudinal and transverse scans. The fifth MTP erosions were detected in 36 of 48 patients (75%) and 67 of 96 feet (69.8%). Of the erosions, 15 (22.4%), 53 (79.1%) and 59 (88.0%) were observed at dorsal, lateral and plantar aspects, respectively. Despite not being statistically different, the detection rate of fifth MTP erosions was numerically higher in the plantar aspect than both the lateral and dorsal aspects. In conclusion, the fifth MTP erosions in RA patients are more commonly detected in the plantar aspect US than in dorsal and lateral assessments.
Collapse
Affiliation(s)
- Nevsun Inanc
- Department of Rheumatology, Faculty of Medicine, Marmara University, Istanbul, Turkey.
| | - Gulsen Ozen
- Department of Rheumatology, Faculty of Medicine, Marmara University, Istanbul, Turkey
| | - Sibel Zehra Aydin
- Department of Rheumatology, School of Medicine, Ottawa University, Ottawa, Ontario, Canada
| | - Esen Kasapoglu-Gunal
- Department of Rheumatology, Faculty of Medicine, Goztepe Medeniyet University, Istanbul, Turkey
| | - Haner Direskeneli
- Department of Rheumatology, Faculty of Medicine, Marmara University, Istanbul, Turkey
| |
Collapse
|
37
|
Ilhan B, Can M, Alibaz-Oner F, Yilmaz-Oner S, Polat-Korkmaz O, Ozen G, Mumcu G, Maradit Kremers H, Direskeneli H. Fatigue in patients with Behçet's syndrome: relationship with quality of life, depression, anxiety, disability and disease activity. Int J Rheum Dis 2016; 21:2139-2145. [DOI: 10.1111/1756-185x.12839] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Birkan Ilhan
- Department of Internal Medicine; School of Medicine; Marmara University; Istanbul Turkey
| | - Meryem Can
- Department of Rheumatology; Fatih Sultan Mehmet Education and Research Hospital; Istanbul Turkey
| | - Fatma Alibaz-Oner
- Department of Rheumatology; School of Medicine; Marmara University; Istanbul Turkey
| | - Sibel Yilmaz-Oner
- Department of Rheumatology; School of Medicine; Marmara University; Istanbul Turkey
| | - Ozge Polat-Korkmaz
- Department of Internal Medicine; School of Medicine; Marmara University; Istanbul Turkey
| | - Gulsen Ozen
- Department of Rheumatology; School of Medicine; Marmara University; Istanbul Turkey
| | - Gonca Mumcu
- Faculty of Health Sciences; Marmara University; Istanbul Turkey
| | | | - Haner Direskeneli
- Department of Rheumatology; School of Medicine; Marmara University; Istanbul Turkey
| |
Collapse
|
38
|
Ozen G, Inanc N, Unal AU, Bas S, Kimyon G, Kisacik B, Onat AM, Murat S, Keskin H, Can M, Mengi A, Cakir N, Balkarli A, Cobankara V, Yilmaz N, Yazici A, Dogru A, Sahin M, Sahin A, Gok K, Senel S, Pamuk ON, Yilmaz S, Bayindir O, Aksu K, Cagatay Y, Akyol L, Sayarlioglu M, Yildirim-Cetin G, Yasar-Bilge S, Yagci I, Aydin SZ, Alibaz-Oner F, Atagunduz P, Direskeneli H. Assessment of the New 2012 EULAR/ACR Clinical Classification Criteria for Polymyalgia Rheumatica: A Prospective Multicenter Study. J Rheumatol 2016; 43:893-900. [DOI: 10.3899/jrheum.151103] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/23/2015] [Indexed: 11/22/2022]
Abstract
Objective.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.
Collapse
|
39
|
Inanc N, Ozen G, Direskeneli H. Predictive value of ultrasonographic assessment of disease activity in response to tumor necrosis factor-α inhibitor treatment in rheumatoid arthritis: a prospective cohort study. Clin Exp Rheumatol 2016; 34:156. [PMID: 26575409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Accepted: 07/27/2015] [Indexed: 06/05/2023]
Affiliation(s)
- Nevsun Inanc
- Marmara University Faculty of Medicine, Department of Rheumatology, Istanbul, Turkey
| | - Gulsen Ozen
- Marmara University Faculty of Medicine, Department of Rheumatology, Istanbul, Turkey.
| | - Haner Direskeneli
- Marmara University Faculty of Medicine, Department of Rheumatology, Istanbul, Turkey
| |
Collapse
|
40
|
Pehlivan E, Ozen G, Taskapan H, Gunes G, Sahin I, Colak C. Identifying the determinants of microalbuminuria in obese patients in primary care units: the effects of blood pressure, random plasma glucose and other risk factors. J Endocrinol Invest 2016; 39:73-82. [PMID: 26093468 DOI: 10.1007/s40618-015-0331-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Accepted: 06/01/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The objective of this study is to evaluate the demographic characteristics, blood pressure and blood glucose and the other related factors that affect the microalbuminuria levels in the obese patients aged 40 and above who applied to the primary care for medical evaluation. MATERIALS AND METHODS The population of the research, which was a cross-sectional type, comprised obese patients aged 40 and above who had applied to the community health centers in the center of Malatya. A total of 422 obese patients consisting of 116 males and 306 females were included in the research. The anthropometric measurements of the participants were determined, their blood pressures and their random blood glucoses were evaluated, as well. A microalbuminuria measurement was performed in the urine samples taken from the patients using "Nycocard Reader II" device. FINDINGS The incidence of microalbuminuria in patients was found as 31.5%, whereas the incidence of macroalbuminuria was 6.6%. The incidence of microalbuminuria in female patients was 32.7%, while it was 28.4% in male patients; on the other hand, the incidence of macroalbuminuria in female patients was found as 6.8%, whereas this percentage was determined as 7.8 in male patients (p > 0.05). The probability of the incidence of microalbuminuria increased 2.8 times more in those with the diastolic blood pressure of 90 mmHg and above when compared to those without it (GA: 1.79-4.56), whereas the incidence increased 3.2 times more in those with the random blood glucose of 200 mg/l and above (GA: 1.32-7.84) (p < 0.001). In our study, among the variables predicting the microalbuminuria in obese patients; the cutoff values of the diastolic and systolic blood pressures, the waist circumference were found as >85 mmHg; >130 mmHg; >141 mg/dl, respectively, in male patients and found as >85 mmHg, >114 cm, and 109 cm, respectively, in female patients. The sensitivity and specificity of the tests indicating the cutoff values showed significance (p < 0.05). There was no statistically significant relevance between the microalbumin levels of the obese patients via the anthropometric criteria, except for their waist circumference (p > 0.05). RESULT In this study, the blood pressure and blood glucose levels of the patients along with their waist circumference that indicated a central obesity were specified as the determinants of microalbuminuria. While the obese patients are being evaluated in terms of proteinuria, the cutoff values of these variables can be taken into consideration.
Collapse
Affiliation(s)
- E Pehlivan
- Public Health Department, Inonu University Medical Faculty, Malatya, Turkey.
| | - G Ozen
- Public Health Department, Inonu University Medical Faculty, Malatya, Turkey
| | - H Taskapan
- Internal Medicine Department, Inonu University Medical Faculty, Malatya, Turkey
| | - G Gunes
- Public Health Department, Inonu University Medical Faculty, Malatya, Turkey
| | - I Sahin
- Internal Medicine Department, Inonu University Medical Faculty, Malatya, Turkey
| | - C Colak
- Biostatistics Department, Inonu University Medical Faculty, Malatya, Turkey
| |
Collapse
|
41
|
Ozen G, Sunbul M, Atagunduz P, Direskeneli H, Tigen K, Inanc N. The 2013 ACC/AHA 10-year atherosclerotic cardiovascular disease risk index is better than SCORE and QRisk II in rheumatoid arthritis: is it enough? Rheumatology (Oxford) 2015; 55:513-22. [PMID: 26472565 DOI: 10.1093/rheumatology/kev363] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVE To determine the ability of the new American College of Cardiology and American Heart Association (ACC/AHA) 10-year atherosclerotic cardiovascular disease (ASCVD) risk algorithm in detecting high cardiovascular (CV) risk, RA patients identified by carotid ultrasonography (US) were compared with Systematic Coronary Risk Evaluation (SCORE) and QRisk II algorithms. METHODS SCORE, QRisk II, 2013 ACC/AHA 10-year ASCVD risk and EULAR recommended modified versions were calculated in 216 RA patients. In sonographic evaluation, carotid intima-media thickness >0.90 mm and/or carotid plaques were used as the gold standard test for subclinical atherosclerosis and high CV risk (US+). RESULTS Eleven (5.1%), 15 (6.9%) and 44 (20.4%) patients were defined as having high CV risk according to SCORE, QRisk II and ACC/AHA 10-year ASCVD risk, respectively. Fifty-two (24.1%) patients were US + and of those, 8 (15.4%), 7 (13.5%) and 23 (44.2%) patients were classified as high CV risk according to SCORE, QRisk II and ACC/AHA 10-year ASCVD risk, respectively. The ACC/AHA 10-year ASCVD risk index better identified US + patients than SCORE and QRisk II (P < 0.0001). With EULAR modification, reclassification from moderate to high risk occurred only in two, five and seven patients according to SCORE, QRisk II and ACC/AHA 10-year ASCVD risk, respectively. CONCLUSION The 2013 ACC/AHA 10-year ASCVD risk estimator was better than the SCORE and QRisk II indices in RA, but still failed to identify 55% of high risk patients. Furthermore adjustment of threshold and EULAR modification did not work well.
Collapse
Affiliation(s)
- Gulsen Ozen
- Department of Rheumatology, Faculty of Medicine, Marmara University, Istanbul, Turkey and
| | - Murat Sunbul
- Department of Cardiology, Faculty of Medicine, Marmara University, Istanbul, Turkey
| | - Pamir Atagunduz
- Department of Rheumatology, Faculty of Medicine, Marmara University, Istanbul, Turkey and
| | - Haner Direskeneli
- Department of Rheumatology, Faculty of Medicine, Marmara University, Istanbul, Turkey and
| | - Kursat Tigen
- Department of Cardiology, Faculty of Medicine, Marmara University, Istanbul, Turkey
| | - Nevsun Inanc
- Department of Rheumatology, Faculty of Medicine, Marmara University, Istanbul, Turkey and
| |
Collapse
|
42
|
Yilmaz-Oner S, Ozen G, Can M, Atagunduz P, Direskeneli H, Inanc N. Biomarkers in Remission According to Different Criteria in Patients with Rheumatoid Arthritis. J Rheumatol 2015; 42:2066-70. [PMID: 26472417 DOI: 10.3899/jrheum.150478] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/28/2015] [Indexed: 01/16/2023]
Abstract
OBJECTIVE Remission is the primary aim in the treatment of patients with rheumatoid arthritis (RA). In this study, we aimed to evaluate biomarker profiles of patients in remission by different criteria and compare these profiles with controls. METHODS Serum levels of calprotectin, interleukin 6 (IL-6), type II collagen helical peptide, C-terminal crosslinking telopeptide of type I collagen generated by matrix metalloproteinases (ICTP), matrix metalloproteinase 3 (MMP-3), resistin, and leptin were measured by ELISA in 80 patients. The patients were in Disease Activity Score at 28 joints with erythrocyte sedimentation rate (DAS28-ESR) remission, and had these characteristics: female/male 54/26, mean age 51.4 ± 12.1 years, mean disease duration 11.4 ± 8.1 years, rheumatoid factor positivity 68.7% (n = 55), anticyclic citrullinated peptide positivity 60.7% (n = 48). These patients were also evaluated for the American College of Rheumatology/European League Against Rheumatism (Boolean) and Simple Disease Activity Index (SDAI) remissions. Additionally, 80 age-, sex-, and comorbidity-matched individuals without rheumatic diseases were included in the study as controls. RESULTS At recruitment of 80 patients in DAS28 remission, 33 patients (41.2%) were found in Boolean remission and 39 patients (48.7%) were in SDAI remission. Serum MMP-3, ICTP, resistin, and IL-6 levels of the 80 patients in DAS28 remission were statistically significantly higher than the controls. Patients in Boolean and SDAI remissions had significantly higher serum ICTP, resistin, and IL-6 levels in comparison with the controls. CONCLUSION The 3 commonly used remission criteria of RA are almost similar with regard to patients' biomarker levels. Biomarker profiles of patients may provide complementary information to clinical evaluation of remission and may help to determine the patients under the risk of progression.
Collapse
Affiliation(s)
- Sibel Yilmaz-Oner
- From the Department of Rheumatology, Medical Faculty, Marmara University, Istanbul, Turkey.S. Yilmaz-Oner, MD, Marmara University, Medical Faculty, Department of Rheumatology; G. Ozen, MD, Marmara University, Medical Faculty, Department of Rheumatology; M. Can, MD, Marmara University, Medical Faculty, Department of Rheumatology; P. Atagunduz, MD, Professor, Marmara University, Medical Faculty, Department of Rheumatology; H. Direskeneli, MD, Professor, Marmara University, Medical Faculty, Department of Rheumatology; N. Inanc, MD, Professor, Marmara University, Medical Faculty, Department of Rheumatology
| | - Gulsen Ozen
- From the Department of Rheumatology, Medical Faculty, Marmara University, Istanbul, Turkey.S. Yilmaz-Oner, MD, Marmara University, Medical Faculty, Department of Rheumatology; G. Ozen, MD, Marmara University, Medical Faculty, Department of Rheumatology; M. Can, MD, Marmara University, Medical Faculty, Department of Rheumatology; P. Atagunduz, MD, Professor, Marmara University, Medical Faculty, Department of Rheumatology; H. Direskeneli, MD, Professor, Marmara University, Medical Faculty, Department of Rheumatology; N. Inanc, MD, Professor, Marmara University, Medical Faculty, Department of Rheumatology
| | - Meryem Can
- From the Department of Rheumatology, Medical Faculty, Marmara University, Istanbul, Turkey.S. Yilmaz-Oner, MD, Marmara University, Medical Faculty, Department of Rheumatology; G. Ozen, MD, Marmara University, Medical Faculty, Department of Rheumatology; M. Can, MD, Marmara University, Medical Faculty, Department of Rheumatology; P. Atagunduz, MD, Professor, Marmara University, Medical Faculty, Department of Rheumatology; H. Direskeneli, MD, Professor, Marmara University, Medical Faculty, Department of Rheumatology; N. Inanc, MD, Professor, Marmara University, Medical Faculty, Department of Rheumatology
| | - Pamir Atagunduz
- From the Department of Rheumatology, Medical Faculty, Marmara University, Istanbul, Turkey.S. Yilmaz-Oner, MD, Marmara University, Medical Faculty, Department of Rheumatology; G. Ozen, MD, Marmara University, Medical Faculty, Department of Rheumatology; M. Can, MD, Marmara University, Medical Faculty, Department of Rheumatology; P. Atagunduz, MD, Professor, Marmara University, Medical Faculty, Department of Rheumatology; H. Direskeneli, MD, Professor, Marmara University, Medical Faculty, Department of Rheumatology; N. Inanc, MD, Professor, Marmara University, Medical Faculty, Department of Rheumatology
| | - Haner Direskeneli
- From the Department of Rheumatology, Medical Faculty, Marmara University, Istanbul, Turkey.S. Yilmaz-Oner, MD, Marmara University, Medical Faculty, Department of Rheumatology; G. Ozen, MD, Marmara University, Medical Faculty, Department of Rheumatology; M. Can, MD, Marmara University, Medical Faculty, Department of Rheumatology; P. Atagunduz, MD, Professor, Marmara University, Medical Faculty, Department of Rheumatology; H. Direskeneli, MD, Professor, Marmara University, Medical Faculty, Department of Rheumatology; N. Inanc, MD, Professor, Marmara University, Medical Faculty, Department of Rheumatology
| | - Nevsun Inanc
- From the Department of Rheumatology, Medical Faculty, Marmara University, Istanbul, Turkey.S. Yilmaz-Oner, MD, Marmara University, Medical Faculty, Department of Rheumatology; G. Ozen, MD, Marmara University, Medical Faculty, Department of Rheumatology; M. Can, MD, Marmara University, Medical Faculty, Department of Rheumatology; P. Atagunduz, MD, Professor, Marmara University, Medical Faculty, Department of Rheumatology; H. Direskeneli, MD, Professor, Marmara University, Medical Faculty, Department of Rheumatology; N. Inanc, MD, Professor, Marmara University, Medical Faculty, Department of Rheumatology.
| |
Collapse
|
43
|
Oksuzoglu K, Ozen G, Inanir S, Direskeneli RH. Flip-flop phenomenon in systemic sclerosis on fluorodeoxyglucose positron emission tomography/computed tomography. Indian J Nucl Med 2015; 30:350-1. [PMID: 26430324 PMCID: PMC4579625 DOI: 10.4103/0972-3919.164018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Systemic sclerosis (SSc) is a rare autoimmune disease, which may affect multiple organ systems. Fluorine-18-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) can demonstrate the degree and anatomical extent of involvement in the entire body and coexisting malignancies in connective tissue diseases. We present a case of SSc with an increased 18F-FDG uptake in the cutaneous and subcutaneous tissues even higher than the neighboring skeletal muscles (“flip-flop phenomenon,” that is, an increased 18F-FDG uptake in the skin but a decreased 18F-FDG uptake in the skeletal muscles).
Collapse
Affiliation(s)
- Kevser Oksuzoglu
- Department of Nuclear Medicine, Marmara University, School of Medicine, Istanbul, Turkey
| | - Gulsen Ozen
- Department of Rheumatology, Marmara University, School of Medicine, Istanbul, Turkey
| | - Sabahat Inanir
- Department of Nuclear Medicine, Marmara University, School of Medicine, Istanbul, Turkey
| | | |
Collapse
|
44
|
Yilmaz N, Emmungil H, Gucenmez S, Ozen G, Yildiz F, Balkarli A, Kimyon G, Coskun BN, Dogan I, Pamuk ON, Yasar S, Cetin GY, Yazici A, Ergulu Esmen S, Cagatay Y, Yilmaz S, Cefle A, Sayarlioglu M, Kasifoglu T, Karadag O, Pehlivan Y, Dalkilic E, Kisacik B, Cobankara V, Erken E, Direskeneli H, Aksu K, Yavuz S. Incidence of Cyclophosphamide-induced Urotoxicity and Protective Effect of Mesna in Rheumatic Diseases. J Rheumatol 2015; 42:1661-6. [DOI: 10.3899/jrheum.150065] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/19/2015] [Indexed: 10/23/2022]
Abstract
Objective.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.
Collapse
|
45
|
Ozen G, Saglam B, Odabasi A, Ozluk O, Yentur S, Saruhan-Direskeneli G, Inanc N, Direskeneli H. AB0264 STAT4 RS7574865 Gene Polymorphism is not Associated with Severe Disease Phenotype and Response to Tumor Necrosis Factor-α Inhibitor Treatment in Patients with Rheumatoid Arthritis. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.2520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
46
|
Ozen G, Korkmaz F, Sunbul M, Deniz R, Tigen K, Atagunduz P, Inanc N, Direskeneli H. SAT0455 Subclinical Atherosclerosis and Estimation of Cardiovascular Risk in Systemic Sclerosis. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.1358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
47
|
Ozen G, Deniz R, Eren F, Erzik C, Aydin S, Inanc N, Direskeneli H, Atagunduz P. FRI0212 Associations of ERAP1, IL23R and PTGER4 Polymorphism with Radiographic Severity of Ankylosing Spondylitis. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.2501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
48
|
Canbolat F, Ozen G, Ozilhan S, Gulturk S, Ozcetin A, Unal A, Inanc N, Atagunduz P, Direskeneli H, Ozden T. THU0549 Relationship Between Colchine Plasma Level and Frequency of Familial Mediterranean Fever Attacks. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.5123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
49
|
Ozen G, Sunbul M, Atagunduz P, Direskeneli H, Tigen K, Inanc N. SAT0103 The 2013 ACC/AHA 10-Year Atherosclerotic Cardiovascular Disease (ASCVD) Risk Index is Better than Score and Qrisk II in Rheumatoid Arthritis: Istanbul it Enough? Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.2176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
50
|
Unal A, Deniz R, Tulunay-Virlan A, Ture-Ozdemir F, Aydin-Tatli I, Ozen G, Alibaz-Oner F, Mumcu G, Ergun T, Direskeneli H. THU0267 IL-17 Expression by Lymphocytes is Higher in Behcet's Disease Compared to Takayasu's Arteritis. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.3440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|