Meral Bilgilisoy Filiz

Objectives: Chronic venous insufficiency (CVI) of the lower extremities negatively affects quality of life due to pain and cosmetic concerns. According to the muscle pump theory, lower extremity muscles contribute significantly to venous return; however, data regarding the relationship between muscle thickness, elasticity, and venous reflux are limited. This prospective study aimed to evaluate the association between lower extremity muscle reserve and elasticity with venous reflux and to investigate the usefulness of shear wave elastography (SWE) in monitoring treatment response. Methods: Between August 2024 and January 2025, 25 consecutive patients with clinically diagnosed CVI were prospectively enrolled in this study. Clinical examination and Clinical–Etiological–Anatomical–Pathophysiological classification were performed in all individuals. Rectus femoris and gastrocnemius muscle thickness were measured by ultrasonography, and elasticity was assessed using SWE. Venous reflux parameters were evaluated with color Doppler ultrasonography. Following baseline assessment, all patients completed a structured physical therapy program. Clinical and radiological evaluations were repeated after treatment; then pre‐ and post‐therapy findings were compared. Results: Thirty‐six extremities of 25 patients (11 bilateral) were included in this study. Post‐treatment measurements demonstrated significant increases in rectus femoris and gastrocnemius muscle thickness and SWE values ( p ≤ .03) and a significant decrease in femoral and popliteal vein reflux times ( p = .01) compared to baseline values. Changes in rectus femoris SWE values showed a weak negative correlation with femoral vein reflux time ( r = −0.36, p = .01). Increased gastrocnemius thickness was weakly and inversely correlated with popliteal vein reflux time ( r = −0.35, p = .01). Conclusions: Muscle thickness and elasticity assessed by ultrasonography and SWE are associated with reflux duration in CVI and may serve as useful adjunctive parameters for evaluating response to physical therapy. Larger studies are needed to confirm their clinical applicability.

Objective: This study aims to evaluate the effectiveness and safety of a single intra-articular injection of high-dose cross-linked hyaluronic acid on pain, physical function, muscle strength, and quality of life in patients with knee osteoarthritis. Methods: This randomized, double-blind, placebo-controlled, cross-over clinical trial includes 102 adults with symptomatic knee osteoarthritis (Kellgren–Lawrence grade II–III). Participants will be allocated using stratified randomization based on radiographic severity and laterality. Patients will receive either intra-articular hyaluronic acid (Semical Gel-B Cross, 90 mg/3 mL) or isotonic saline (3 mL of 0.9% NaCl), followed by cross-over at the 3-month evaluation. Outcomes will be assessed at baseline and at 3, 6, 9, and 12 months. The primary efficacy endpoint is the between-group difference in WOMAC pain score at the 3-month assessment prior to cross-over. Secondary outcomes include VAS pain, WOMAC physical function and stiffness scores, isometric quadriceps and hamstring strength, quality of life (SF-36), the 6-minute walk test, the 5-times sit-to-stand test, analgesic use, and adverse events. Treatment response will additionally be categorized as “absolute responders” (≥50% and ≥20-point improvement in VAS) and “responders” (≥20% and ≥10-point improvement). Sample size was calculated using G*Power (effect size 0.5, 80% power), yielding 102 participants. Statistical analyses will include both intention-to-treat and per-protocol approaches. Expected results and conclusions: This study will provide 3-month efficacy data and long-term (3–12 months) safety outcomes for high-dose intra-articular hyaluronic acid compared with placebo. Findings are expected to inform clinical decision-making regarding symptom relief, functional improvement, and the safety profile of cross-linked HA formulations in knee osteoarthritis. Trial registration: ClinicalTrials.gov: NCT06141018

Artificial intelligence (AI)-driven chatbots, such as ChatGPT, have the potential to improve healthcare communication by providing timely and accessible medical information. Duchenne Muscular Dystrophy (DMD) is a progressive neuromuscular disorder that significantly impacts patients and their families. Parents of DMD patients seek reliable information on disease progression, complications, and care management. However, the effectiveness of AI-generated medical guidance remains unclear. This study evaluated ChatGPT's capacity to provide guidance to DMD patients' families by analyzing expert and parental assessments. Ten frequently asked questions were compiled from parental inquiries and submitted to ChatGPT-4o. Responses were evaluated by physiatrists, pediatric neurologists, and parents using structured rubrics. Experts rated responses based on Accuracy, Currency, Comprehensiveness, Usefulness, and Understandability, while parents assessed them in terms of Satisfaction, Empathy, Comprehensiveness, and Understandability. Experts rated Accuracy highest (4.3 ± 0.6; 91.8% of ratings ≥ 4), followed by Usefulness (4.2 ± 0.6; 88.6%), Currency (4.2 ± 0.7; 87.1%), Comprehensiveness (4.2 ± 0.7; 85.1%), and Understandability (4.2 ± 0.7; 83.4%). Parents rated Understandability highest (4.5 ± 0.8; 86.0%), followed by Comprehensiveness (4.4 ± 0.8; 84.0%) and Satisfaction (4.4 ± 0.8; 83.8%). Empathy received the lowest parental score (4.2 ± 0.9; 75.1%). Although both groups generally evaluated the responses favorably (median scores ≥ 4), experts tended to prioritize technical accuracy, whereas parents placed greater emphasis on clarity and practical usefulness. ChatGPT shows promise as an informational tool for parents of DMD, particularly in providing accurate and applicable medical guidance. However, limitations in empathy suggest a need for refinement. While ChatGPT should complement rather than replace human expertise, future improvements could expand its role in patient education and public health. Further research is needed to optimize AI-driven healthcare communication for reliability and ethical considerations.

Advancements in artificial intelligence have led to the widespread use of large language models such as ChatGPT in healthcare communication. Myotonic dystrophy type 1, a chronic and multisystemic neuromuscular disorder, poses significant challenges for patients in understanding disease progression, symptom management, and future planning. Given the scarcity of specialized resources for rare diseases, AI-based tools may offer valuable support by delivering accessible and relevant information. This study aimed to evaluate ChatGPT-4o's performance in addressing patient-centered questions about myotonic dystrophy type 1. This descriptive methodological study utilized ten frequently asked patient-style questions concerning myotonic dystrophy type 1, posed to ChatGPT-4o in Turkish using a standardized zero-shot prompting approach. A total of 53 specialist physicians in Physical Medicine and Rehabilitation and Neurology assessed the responses using a structured rubric across five domains: accuracy, currency, comprehensiveness, usefulness, and understandability. Each response was scored from 1 to 5. ChatGPT-4o achieved high specialist physicians' satisfaction across all domains, with over 80% of responses rated ≥ 4. Accuracy received the highest score (85.7%), followed by usefulness and comprehensiveness (above 82%). Currency and understandability were rated slightly lower (81.9% and 81.5%, respectively). ChatGPT-4o generated responses that were generally accurate, relevant, and understandable, demonstrating promise as an accessible resource for rare disease contexts such as myotonic dystrophy type 1. It also showed strong potential as a supportive informational tool for specialist physicians. Ongoing model refinement and integration with up-to-date clinical data are essential to optimize its performance and ensure its safe, equitable use in healthcare communication.

Background/Aims: This study compared the mid-term effectiveness of ultrasoundguided (USG) vs. landmark (LM)-guided corticosteroid injections in patients with moderate carpal tunnel syndrome (CTS), evaluating symptom severity, functional status, sonographic and electrophysiological parameters, and complications over 6 months. Materials and Methods: A prospective, randomized, double-blind trial was conducted on 168 wrists (84 participants) with bilateral moderate CTS. Participants were divided into LM-guided and USG injection groups. Primary outcomes included the Boston Carpal Tunnel Syndrome Questionnaire (BCTQ) Symptom Severity Scale (SSS) and Functional Status Scale (FSS). Secondary outcomes were grip strength (GS), median nerve cross-sectional area (MNSA), median nerve flattening ratio (MNFR), and electrophysiological parameters. Assessments were performed at baseline, 1 month, and 6 months post injection. Results: Both groups showed significant improvements in BCTQ-SSS, BCTQ-FSS, GS, MNSA, MNFR, and electrophysiological parameters at 1 and 6 months (P < .05). No significant differences were observed between the 2 techniques in efficacy. However, hypopigmentation occurred more frequently in the LM group (11% vs. 3%, P = .04). No severe complications were reported. Conclusion: The USG and LM-guided corticosteroid injections are equally effective for moderate CTS over 6 months. While USG may reduce minor complications like hypopigmentation, both methods are safe and viable options when performed by experienced clinicians. Cite this article as: Topcu-Altın N, Sarı MH, Bilgilisoy-Filiz M, et al. Efficacy of ultrasound versus landmark-guided steroid injections for carpal tunnel syndrome: A randomized doubleblind trial. ArchRheumatol. 2026;41(1):22-28.

Objective: This study aimed to compare the clinical effectiveness of 5% and 15% dextrose prolotherapy (PrT), combined with exercise therapy and bracing, versus exercise therapy alone in patients with chronic lateral epicondylitis (LE). Methods: This retrospective study included patients with LE, and participants were divided into three groups: exercise only ( n = 29), 5% PrT + exercise ( n = 30), and 15% PrT + exercise ( n = 36). PrT was performed under ultrasound guidance at weeks 0, 3, and 6 targeting the forearm extensor muscles and annular ligament entheses. All patients used an epicondylitis brace and followed a 12-week home exercise program. Pain [visual analog scale (VAS)], function [patient-rated tennis elbow evaluation (PRTEE)], and grip strength were measured at baseline, week 6, and week 12. Results: All groups showed significant within-group improvements in VAS, PRTEE, and grip strength. Both PrT groups had significantly greater improvements in pain and function than those of the exercise-only group at weeks 6 and 12. Grip strength in flexion was significantly higher in both PrT groups than that in the exercise group at week 12. No significant differences were found between the 5% and 15% PrT groups in extension and pinch grip strength across groups. Conclusion: 5% and 15% dextrose prolotherapy are both more effective than exercise alone in improving pain, function, and grip strength in chronic LE. The increased handgrip strength at week 12 suggests that prolotherapy may aid muscle strength recovery. The absence of significant differences between the prolotherapy groups indicates that higher concentrations of dextrose may not be necessary to achieve clinical improvement.

Objective: Carpal tunnel syndrome (CTS) is a common entrapment neuropathy caused by median nerve compression. Steroid injections provide temporary relief in mild to moderate CTS, whereas 5% dextrose prolotherapy (PrT) has recently emerged as a regenerative alternative. This study compares the efficacy of ultrasound-guided perineural 5% dextrose PrT and corticosteroid injections. Methods: In this retrospective analysis, 74 individuals aged between 18 and 70 years, meeting both clinical and electrophysiological criteria for mild to moderate CTS, were included. 36 patients received a single ultrasound-guided injection of 40 mg triamcinolone acetonide (steroid group), while 38 patients underwent three perineural 5% dextrose PrT sessions at three-week intervals (PrT group). All patients followed a 12-week conservative protocol with wrist splinting and nerve/tendon gliding exercises. Outcomes were assessed at baseline, week 6, and week 24. The primary outcome was Visual Analog Scale (VAS) pain and numbness score. Secondary outcomes were QuickDASH, grip and pinch strengths, and median nerve conduction studies. Results: Both groups showed significant within-group clinical and functional improvements (p<0.05). At 6 weeks, the steroid group showed higher grip strength compared with PrT (MD = −1.25, 95% CI −4.12 to 1.62, p = 0.048) and pinch (MD = −0.32, 95% CI −0.87 to 0.23, p = 0.005) compared with the prolotherapy group. At 24 weeks, PrT resulted in lower daytime pain VAS compared with steroids (MD −1.15, 95% CI −2.23 to −0.07, p = 0.026), surpassing the minimal clinically important difference (MCID) for CTS pain reduction. Electrophysiological improvements occurred only in the steroid group, especially in motor and sensory conduction parameters, without corresponding long-term clinical superiority. Conclusion: Perineural PrT and steroid injections appear to be effective non-surgical options for managing mild to moderate CTS. While steroids may provide faster symptom relief and earlier improvements in strength, dextrose PrT demonstrated more sustained pain reduction. It should be noted, however, that the injection protocols differed—the steroid group received a single dose, whereas the PrT group underwent three sessions—an approach based on our review of the existing literature. This discrepancy should be considered when interpreting the results. Further randomized controlled trials are needed to confirm these findings and clarify the regenerative mechanisms of dextrose prolotherapy.

Introduction Lateral epicondylitis (LE) is a musculoskeletal disorder characterized by pain around the lateral epicondyle. Posterior interosseous nerve syndrome (PINS), a rare neuropathy caused by radial nerve compression, can mimic or coexist with LE, complicating diagnosis. This study aimed to evaluate the electrophysiological presence of PINS in LE and determine its impact on symptoms. Methods This prospective study included 62 patients diagnosed with LE and 54 healthy controls. Electrophysiological examinations were performed on all patients in the LE group to investigate the presence of PINS. Subsequently, PINS-positive and PINS-negative patients within the LE group underwent a detailed clinical evaluation, including provocative tests, joint range of motion (ROM), hand grip strength, and symptom scoring using the Visual Analog Scale (VAS) and Patient-Rated Tennis Elbow Evaluation (PRTEE). Results PINS was identified in 19.4% of LE patients and 1.9% of controls (p < 0.05). There were no significant differences between PINS-positive and PINS-negative patients in the LE group regarding provocative tests, joint ROM, grip strength, VAS, or PRTEE scores. The diagnosis of PINS was made solely based on electrophysiological findings. Discussion This study highlights the importance of electrophysiological evaluation in the differential diagnosis of PINS and LE, especially in treatment-resistant cases. Although PINS did not significantly impact clinical parameters such as grip strength or symptom scores, its notable prevalence in LE patients underscores the need for its consideration in refractory LE cases. Further large-scale, controlled studies are needed to explore this relationship comprehensively.

Objectives: The purpose of the study was to contribute further to this debated topic by investigating the correlation of magnetic resonance imaging (MRI) findings with the clinical picture in lumbar spondylosis patients. Patients and methods: This multicenter retrospective study (as part of the epidemiological project of the TLAR-OASG [Turkish League Against Rheumatism-Osteoarthritis Study Group]) included 514 patients (101 males, 413 females; mean age: 63.6±10.8 years; range, 40 to 85 years) who were diagnosed as lumbar spondylosis by clinical examination and direct X-ray between December 2016 and June 2018. Demographic characteristics of patients, Visual Analog Scale for pain, presence of radiating pain, Roland-Morris disability questionnaire, straight leg raise test, deep tendon reflexes, neurogenic intermittent claudication symptoms, any decrease of muscle strength, and abnormality of sensation were recorded. Lumbar MRI findings of the patients were recorded as positive or negative in terms of disc herniation, intervertebral disc degeneration, root compression, osteophytes, spinal stenosis. Statistical analysis was done to assess the correlation between the clinical symptoms, physical examination, and MRI findings. Results: Correlation analysis of the MRI results and the clinical findings showed a significant correlation between straight leg raise test and root compression (p