Bilal Uysal

Aim This study compared isokinetic strengthening and home-based exercise combined with intra-articular hyaluronic acid (IAHA) and evaluated the additional benefits of exercise over IAHA alone in knee osteoarthritis (OA). Methods In this randomized controlled trial, 54 patients with knee OA were assessed; five were excluded before randomization because of knee joint infection (n = 1), major trauma or surgery (n = 1), or voluntary withdrawal (n = 3). The remaining 49 patients were randomized to IAHA plus isokinetic strengthening, IAHA plus home-based exercise, or IAHA alone, and all completed follow-up. IAHA was administered weekly for 3 weeks. The isokinetic group completed 12 supervised sessions over 4 weeks, whereas the home-based group exercised twice daily, 5 days/week, for 4 weeks. Outcomes were assessed at baseline, week 4, and 6 months using the visual analog scale, Western Ontario and McMaster Universities Osteoarthritis Index, Lequesne knee index, Health Assessment Questionnaire, mean absolute angular error, and knee extensor and flexor peak torque at 60°/s and 180°/s. Results Baseline characteristics were comparable among groups. All groups showed significant improvements in pain, function, and proprioception over time. Between-group analyses favored isokinetic strengthening for pain, disability, and proprioception after treatment and/or at 6 months. Knee extensor strength improved in both exercise groups, with more consistent gains in the isokinetic group (P < .05). Conclusion IAHA improved symptoms in knee OA, while exercise provided additional neuromuscular benefits. Isokinetic strengthening produced greater improvements in selected outcomes, whereas home-based exercise remained a practical option.

Background: Plantar fasciitis is traditionally considered a predominantly nociceptive disorder; however, chronic plantar heel pain may include neuropathic-like and nociplastic features that influence clinical presentation and outcomes. This study aimed to describe the distribution of pain phenotypes in patients with plantar fasciitis and to compare clinical, psychological, functional, and quality-of-life outcomes across phenotypes. Methods: In this prospectively recruited cross-sectional study, 100 adults with clinically diagnosed plantar fasciitis of at least three months' duration were classified using a hierarchical phenotype algorithm. Neuropathic-like features were identified using the Douleur Neuropathique 4 questionnaire (DN4 ≥4). Among patients not meeting this criterion, nociplastic features were classified according to clinical criteria for nociplastic musculoskeletal pain; remaining patients were classified as predominantly nociceptive. Outcomes included pain intensity, heel tenderness, pain catastrophizing, depressive symptoms, central sensitization, foot function, and SF-12 raw physical and mental composite scores. Results: Thirty-six patients were classified as nociceptive, 31 as neuropathic-like, and 33 as nociplastic. Pain intensity did not differ significantly between groups. In contrast, the neuropathic-like and nociplastic groups showed higher central sensitization and depressive symptom scores and lower SF-12 physical and mental composite scores than the nociceptive group. The neuropathic-like group also showed greater heel tenderness and worse foot function. Age- and sex-adjusted regression models supported independent associations between non-nociceptive phenotypes and several adverse patient-reported outcomes, particularly central sensitization and depressive symptoms. Conclusions: Pain phenotypes in plantar fasciitis are heterogeneous. Identifying neuropathic-like and nociplastic features may improve clinical assessment and support more individualized, mechanism-informed management strategies.

Does Hypermobility Syndrome Affect Bone Density? - Turkish Journal of Osteoporosis

Objective: To evaluate the readability, information quality/reliability, content coverage, and technical performance of Turkish-language online resources that provide information on psoriatic arthritis (PsA). Methods: In April 2025, a Google search was performed using the keywords “psoriatic arthritis” and “psoriasis rheumatism.” Turkish language websites appearing within the first 10 pages of the search results and providing direct PsA information were included. Dictionaries, social media platforms, and duplicate pages were excluded from the study. The websites were categorized according to the provider type. Readability was assessed using the Ateşman and Bezirci-Yılmaz formulas; information quality and transparency using modified DISCERN and JAMA benchmarks; content coverage using five patient-oriented questions derived from UpToDate; and technical performance using Google Lighthouse scores (Performance, Accessibility, Best Practices, SEO). Results: Results: Fifty-seven websites were analyzed. The mean readability scores were 49.12±8.81 and 17.67 ± 4.01 for the Ateşman and Bezirci-Yılmaz scales, respectively, indicating moderate difficulty and an education level approximately at the university range for comfortable comprehension. The mean scores were 1.07 ± 0.84 for JAMA and 2.18 ± 0.57 for modified DISCERN, reflecting low transparency and low-to-moderate information quality. The mean content coverage score was 3.58±1.12 (0-5); Although most sites defined PsA (96.4%) and described symptoms (91.2%), only 15.8% included self-management guidance. Technical evaluations revealed low average Lighthouse scores, particularly for performance (45.98±32.78). Conclusion: Conclusion: Turkish-language online information about PsA shows limitations in terms of readability, transparency, and content depth, especially regarding self-management. Because the study did not assess patient exposure, usage patterns, or clinical outcomes, the findings should be interpreted as a cross-sectional assessment of the Turkish-language online information environment, not a direct measure of delivered patient education. Improving readability, transparency signals (authorship, references, update dates), and coverage of practical self-management topics may enhance the usefulness of online resources for patients with PsA.

SUMMARY OBJECTIVE: Rheumatoid arthritis is associated with osteoporosis and falls. While anticholinergic burden increases fracture risk in older adults, its contribution to bone health in rheumatoid arthritis is unclear. The aim of this study was to determine if anticholinergic burden is an independent risk factor for osteoporosis and fracture in rheumatoid arthritis. METHODS: This retrospective cohort study included 120 adults with rheumatoid arthritis. Cumulative anticholinergic burden was quantified using eight validated scales (anticholinergic burden, Anticholinergic Risk Scale, Anticholinergic Drug Scale, Clinician-rated Anticholinergic Scale, Anticholinergic Activity Scale, Anticholinergic Effect on Cognition Scale, Anticholinergic Loading Scale, and CRIDECO). Outcomes included lumbar spine and hip bone mineral density, Fracture Risk Assessment Tool 10-year fracture probabilities, and World Health Organization-defined osteoporosis. Fracture Risk Assessment Tool major and L1-L4 T-score models included age, body mass index, rheumatoid arthritis duration, anticholinergic burden Calc Score, and Anticholinergic Drug Scale Score, whereas the binary osteoporosis model included age, body mass index, comorbidity count, anticholinergic burden Calc Score, and Anticholinergic Drug Scale Score. RESULTS: In unadjusted analyses, only Clinician-rated Anticholinergic Scale ≥1 was associated with osteoporosis (p=0.010), whereas the other thresholdbased scales were not. After adjustment for the covariates specified in each model, neither anticholinergic burden Calc Score nor Anticholinergic Drug Scale Score independently predicted Fracture Risk Assessment Tool major probability (p=0.415 and p=0.189), L1–L4 T-score (p=0.436 and p=0.291), or binary osteoporosis status (p=0.849 and p=0.653). Age remained the only independent predictor in the osteoporosis model (OR 1.083; 95%CI 1.019–1.151; p=0.010), whereas older age and lower body mass index predicted higher Fracture Risk Assessment Tool major probability. CONCLUSION: In rheumatoid arthritis, the apparent relationship between anticholinergic burden and osteoporosis is largely explained by age, body composition, and comorbidity-related prescribing. Although anticholinergic burden was not an independent fracture risk factor after adjustment, higher anticholinergic burden may still reflect greater prescribing complexity and comorbidity burden in rheumatoid arthritis.

Background and Objectives: This study investigated the impact of nutritional status and foods consumed on inflammation and disease activity in patients with rheumatoid arthritis (RA). Materials and Methods: We designed a cross-sectional observational study, involving 110 patients diagnosed with RA. The patients included were between 18 and 75 years old, diagnosed with rheumatoid arthritis two years ago or earlier, with stable treatment for the last 8 weeks. Data on anthropometric parameters, body mass composition, nutritional status, individual food consumption records, inflammation, disease activity, quality of life, clinical, and laboratory parameters were collected for each study participant. The evaluation parameters of the patients were the simple disease activity index (SDAI), clinical disease activity index (CDAI), systemic immune-inflammation index (SII) and individual food consumption records. A bioimpedance device and measuring tape were used to take body composition and anthropometric measurements of the patients. Results: According to the body mass index, waist circumference and waist-to-height ratio, in our study, we found that 60% of the patients were obese, 80% were at a very high health risk, and approximately 91% were in need of nutritional treatment. There was a significant negative correlation between the dietary intake of total energy, total fat, omega 3, calcium, zinc, cobalamin and the disease activity (SDAI, CDAI). There was a significant negative correlation between polyunsaturated fatty acids, omega 3, carotene, vitamin E, selenium and the SII. Additionally, there was a positive correlation between omega 6 and the SII, SDAI, CDAI (p < 0.05). Conclusions: The results of this study show that the foods consumed in the nutrition of RA patients may have effects on their inflammation and disease activity.

Objective: This study aimed to investigate whether balneotherapy triggers inflammation and improves the disease activity, pain and quality of life in patients with ankylosing spondylitis Materials and Method: This study was planned as a prospective, controlled, single-blind study. A total of 60 patients were divided into two groups. Group I was treated balneotherapy. No additional treatment was applied to the control group. All the patients continued their daily routine lifestyles and pharmacological treatments. Assessments were made using the Pain VAS, Patient Global VAS, BASFI, BASDAI, ASQoL, WBC, ESR and CRP at the beginning of treatment and at the end of treatment (day 21). Results: Compared to the pre-treatment period, there was a statistically significant improvement in both groups’ pain at the end of the treatment in BASFI, in the Balneotherapy group (VAS), in the patient’s global assessment (VAS), in ASQoL and BASDAI. A comparison between groups before treatment revealed that there was a statistically significant difference in terms of pain (VAS), patient’s global assessment (VAS), BASFI and BASDAI whereas, after treatment, there was no statistically significant difference in the data except pain (VAS).A comparison of difference scores revealed that there was a statistically significant change in pain (VAS), patient’s global assessment (VAS), ASQoL, BASFI and BASDAI whereas there was no statistically significant difference between WBC, ESR and CRP. Conclusion: Balneotherapy is well tolerated and balneotherapy combined with pharmacological treatment may improve the beneficial effects of treatment in ankylosing spondylitis patients.