Emre Uzun

Knee osteoarthritis is a prevalent joint disorder globally, resulting in pain and disability, with various treatment options available. Intra-articular ozone (O ₂ –O ₃ ) administrations are an efficient therapeutic approach commonly employed in this condition. With this study, we aimed to compare the effect of varying ozone concentrations on treatment outcomes. This multicenter retrospective cohort study was conducted at 2 distinct university hospitals between May 2023 and September 2024. Medical records of patients who underwent intra-articular knee ozone injections were retrospectively reviewed and divided into 2 groups as 15 μg/mL (group A) and 25 μg/mL ozone (group B). Participants’ pain scores were measured by Numeric Rating Scale, functional status by Western Ontario and McMaster Universities Osteoarthritis Index and quality of life by 12-item Short Form Health Survey before and at 1 and 3 months following ozone therapy. A total of 190 patients were screened; 159 patients (105 females, 54 males) were included in the study, with 77 patients in group A and 82 patients in group B. Both groups demonstrated significant improvements in all outcomes during follow-up. After adjustment for multiple comparisons, between-group differences in Numeric Rating Scale scores were not statistically significant at either 1 or 3 months. Group B had significantly better Western Ontario and McMaster Universities Osteoarthritis Index, 12-item Short Form Health Survey physical component summary, and 12-item Short Form Health Survey mental component summary scores at both follow-up assessments (all Holm-adjusted P < .001). The 25 μg/mL concentration was associated with more favorable short-term functional and quality-of-life outcomes and a trend toward greater pain improvement. These findings should be considered exploratory and require confirmation in prospective randomized studies.

Objective: Behçet’s disease (BD) is a systemic vasculitis characterized by thrombo-inflammation. This cross-sectional study compared inflammatory indices obtained from complete blood counts (CBC), focusing particularly on red blood cell distribution width (RDW), with conventional acute-phase reactants (CRP, ESR). It examined phenotype-specific hematological patterns across clinical manifestations and the cross-sectional relationships of hematological parameters and vascular involvement with treatments. Subjects and Methods: A total of 100 BD patients (ISG criteria) and 42 age- and sex-comparable healthy controls were studied. RDW, MPV, PHR, and CBC-derived indices (NLR, PLR, MLR, SII, SIRI, AISI) were calculated. Disease activity (BDCAF), clinical manifestations (DVT, composite vascular complications, genital ulcer history, arthralgia, pathergy), and treatment regimens were recorded. Between-group comparisons used the Mann–Whitney U test; separation from controls was assessed by ROC analysis with Youden-derived cut-offs. The Benjamini–Hochberg procedure controlled the false discovery rate (FDR) across subgroup comparisons. Results: CRP (p = 0.299) and ESR (p = 0.184) did not differ between groups, whereas RDW (median 15.05% [IQR 13.57–16.32] vs. 13.45% [12.90–13.70], p < 0.001) and MPV (8.85 fL [8.38–10.00] vs. 10.05 fL [9.30–10.60], p < 0.001) did. RDW showed the highest observed AUC for separation from controls (AUC 0.77; cut-off > 13.95), followed by MPV (AUC 0.72); CRP (AUC 0.551) and NLR (AUC 0.49) were uninformative. PHR was nominally lower in DVT (median 17.08 [IQR 15.66–18.97] vs. 20.08 [16.54–25.64], p = 0.043) and composite vascular complications (17.16 [15.23–19.28] vs. 20.22 [16.66–26.26], p = 0.024), accompanied by higher hemoglobin (p = 0.013) and hematocrit (p = 0.006). RDW was lower in patients with a history of genital ulcers (13.65% [IQR 13.07–14.35] vs. 15.70% [14.17–16.45], p < 0.001). After Benjamini–Hochberg correction, the BD–control differences and the genital ulcer–RDW association remained significant, whereas marginal subgroup associations (DVT–PHR, pathergy–SIRI/AISI; p = 0.02–0.05) did not. Colchicine use was nominally associated with a lower DVT frequency (8.1% vs. 28.6%; OR 0.23, 95% CI 0.05–1.24), an unstable, exploratory finding based on only 14 non-users and substantially confounded by indication. Conclusions: In BD, CBC-derived indices, particularly RDW and MPV, separated BD patients from healthy controls even when conventional acute-phase reactants (CRP and ESR) remained normal, although this reflects separation from health rather than diagnostic accuracy for BD. RDW was lower in patients with a history of genital ulcers, while an exploratory PHR signal in deep vein thrombosis was inconclusive. These readily accessible indices may serve as complementary markers in BD, pending validation in disease-controlled prospective studies.

Aim: Our aim in this study was to compare the reliability and clinical usefulness of answers generated by ChatGPT’s GPT-5.1 Instant and GPT-5.1 Thinking models for the most frequently searched patient questions on lateral epicondylitis.Materials and Methods: This study was designed as a pilot, descriptive, expert-evaluated large language model (LLM) output assessment study. Google Trends was queried for “tennis elbow” and “lateral epicondylitis”. The six highest-ranked questions were posed to GPT-5.1 Instant and GPT-5.1 Thinking. Three senior physiatrists independently rated every response using the seven-point Reliability and Usefulness Scales. Results: Both models produced reliable and moderately useful responses. Mean ± SD reliability scores were 5.11 ± 1.18 for GPT-5.1 Instant and 5.06 ± 1.21 for GPT-5.1 Thinking, while usefulness scores were 5.22 ± 1.22 and 5.50 ± 1.38, respectively. Differences were not statistically significant (reliability Z = -1.00, p = 0.317, r ≈ 0.41; usefulness Z = -1.60, p = 0.109, r ≈ 0.65), though GPT-5.1 Thinking trended higher in usefulness. Inter-rater agreement was excellent for all ratings (ICC = 0.94-0.98), indicating consistent scoring.Conclusion: GPT-5.1 Instant and GPT-5.1 Thinking both delivered reliable, moderately useful information on lateral epicondylitis, with GPT-5.1 Thinking showing a numerically higher usefulness score that did not reach statistical significance. These findings support ChatGPT’s potential as patient-education aid for musculoskeletal disorders while underscoring the need for expert oversight and further research across broader topics, languages, and chatbot platforms.

Objective: Plantar fasciitis is a common degenerative condition causing chronic heel pain and functional limitation. Corticosteroid injections are widely used but carry potential adverse effects, whereas ozone therapy has emerged as an alternative with anti-inflammatory and regenerative properties.The aim of this study is to compare the efficacy of ultrasound-guided corticosteroid and ozone injections on pain, function, and quality of life in chronic plantar fasciitis.Methods: This retrospective cohort study included 59 patients unresponsive to conservative treatment. Patients received either a single corticosteroid injection (Group S, n=30) or three weekly ozone injections (Group O, n=29). Outcomes were assessed using the Numerical Rating Scale (NRS), Foot Function Index (FFI), and Short Form-12 (SF-12) at baseline, 1 month, and 3 months. Treatment response was defined as ≥50% reduction in NRS.Results: Both groups showed significant improvement over time (p<0.001). Pain reduction was similar at 1 month. At 3 months, corticosteroids resulted in lower NRS scores (p=0.024) and higher responder rates (70.0% vs. 31.0%, p=0.003). Corticosteroids provided greater short-term functional improvement, whereas ozone showed superior FFI scores at 3 months (p<0.001). SF-12 physical scores improved similarly; mental scores favored corticosteroids (p=0.025). No serious adverse events occurred.Conclusions: Both injections effectively improve pain, function, and quality of life in plantar fasciitis. Corticosteroids provide superior pain relief, while ozone may offer better long-term functional improvement. Treatment selection should be individualized based on clinical priorities.

Objective: Knee osteoarthritis (KOA) is a major cause of pain and disability, particularly in the advanced stages, where treatment options are limited. Platelet-rich plasma (PRP) and ozone therapy have individually demonstrated beneficial effects. However, evidence regarding their combined use, especially in severe KOA, remains scarce. Therefore, with this study, we aimed to evaluate the efficacy of combined intra-articular PRP and ozone injections in patients with advanced knee osteoarthritis.Methods: This study included 61 patients with advanced KOA who were treated with three ultrasound-guided intraarticular injections of PRP, followed by ozone at two-week intervals. Pain and function were assessed using the Numerical Rating Scale (NRS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) at baseline, 1month, and 3 months.Results: Significant improvements were observed in both pain and functional scores over time (P < 0.001). The mean NRS decreased from 7.70 ± 1.37 at baseline to 4.54 ± 1.15 at 1 month, increasing to 6.33 ± 1.29 at 3 months. WOMAC scores improved from 73.61 ± 12.64 to 54.44 ± 11.67 at 1 month but returned to near baseline (73.21 ± 12.33) at 3 months. At 1 month, 90.2% of patients achieved ≥30% pain reduction, decreasing to 9.8% at 3 months.Conclusion: Combined PRP and ozone therapy provides substantial short-term improvements in advanced KOA in terms of pain and function. Yet, these benefits decrease notably within 3 months. This treatment may be considered a short-term or adjunctive option rather than a durable, long-term solution.

Background/Objectives: Posterior knee pain is a common but often overlooked component of knee osteoarthritis (KOA), especially in advanced stages. Conventional nerve blocks targeting anterior innervation may provide insufficient relief. The IPACK block selectively targets posterior capsular innervation; however, evidence for its effectiveness in chronic KOA-related posterior pain remains limited. Methods: In this multicenter, prospective, single-arm, nonrandomized interventional study, patients aged 50–90 years with Kellgren–Lawrence grade III-IV KOA and predominant posterior knee pain unresponsive to conservative treatment received an ultrasound-guided IPACK block. Pain (NRS), function (WOMAC), and quality of life (SF-12) were assessed at baseline, 1 month, and 3 months. Results: Eighty-four patients (84 knees) were included. Mean NRS decreased from 7.8 ± 1.3 to 3.5 ± 1.5 at 1 month and 6.7 ± 1.3 at 3 months (p < 0.001). WOMAC improved from 71.5 ± 11.0 to 37.3 ± 10.4 and 60.2 ± 10.5 at 1 and 3 months, respectively (p < 0.001). SF-12 physical and mental scores also improved significantly (p < 0.001). Conclusions: Improvements in pain, physical function, and health-related quality-of-life measures were observed during the three-month period following the IPACK block. No serious procedure-related adverse events were recorded during the three-month follow-up period.

Background/Objectives: Although vitamin K has been implicated in osteoarthritis pathophysiology, the specific effects of vitamin K2 (menaquinone) on cartilage degeneration remain poorly characterized. This study aimed to investigate the effect of oral vitamin K2 supplementation in a monosodium iodoacetate-induced osteoarthritis model. Methods: Twenty-four male Sprague Dawley rats were included in the study and divided into 3 equal groups: sham group, control (osteoarthritis) group, and treatment group. Saline was applied to the right knee of the sham group, and MIA was applied intra-articularly to the right knee of the control and treatment groups to create an osteoarthritis model. Rats in the treatment group were given 8 micrograms (μg)/day of vitamin K2 orally in addition to the standard diet. After 28 days of follow-up, all rats were euthanized. The right knee articular cartilage was examined histologically with Hematoxylin–Eosin and Safranin O and immunohistochemically with type II collagen alpha 1 and Matrix Metalloproteinase-13. Results: Histological evaluation demonstrated significantly lower Mankin scores in the treatment group (4.25 ± 0.83) compared with the control group (11.10 ± 0.83). Immunohistochemical analysis showed more intense type II collagen staining and reduced matrix metalloproteinase-13 staining in the treatment group relative to the control group. Conclusions: Oral vitamin K2 administration was associated with reduced cartilage degeneration and improved matrix preservation at the 28-day endpoint in an induced MIA osteoarthritis rat model.

This study aimed to compare the prevalence and severity of central sensitization (CS) between patients with psoriatic arthritis (PsA) and rheumatoid arthritis (RA). Also, we investigated clinical correlates of CS, its impact on disease burden, and factors associated with CS in these patients. This cross-sectional study was conducted in the Department of Rheumatology outpatient clinic between May 2025 and January 2026. Ninety-three patients with PsA and ninety-two patients with RA meeting were included. CS was assessed using the Central Sensitization Inventory (CSI). Sleep quality was evaluated using the Pittsburgh Sleep Quality Index (PSQI), and neuropathic pain–like symptoms were assessed with the painDETECT questionnaire (PDQ). Multivariable linear regression analyses were performed to examine whether disease diagnosis (RA vs PsA) was independently associated with CSI scores and to identify variables independently related to CS. CS (CSI ≥40) was present in 48.6% of the cohort, and CSI scores were significantly higher in PsA. Patients with CS demonstrated higher tender joint counts, disease activity (DAS28), pain intensity, and patient- and physician-reported global assessments (all p<0.001). Impaired sleep quality and neuropathic pain–like symptoms were also significantly more pronounced in the CS group. CSI scores showed strong correlations with pain intensity, disease activity, tender joint counts, and poor sleep quality. In multivariable regression analysis, poorer sleep quality remained significantly associated with higher CSI scores (B=1.94, 95% CI 1.32–2.55; p<0.001). Fibromyalgia was also independently associated with higher CSI scores (B=11.79; 95% CI 5.57–18.02; p<0.001), whereas disease diagnosis (RA vs PsA), inflammatory markers, and treatment modality were not associated with CSI scores. Central sensitization may develop independently of arthritis phenotype but appears to impose a greater clinical burden in PsA. Early multidimensional evaluation of pain mechanisms, alongside inflammatory activity, may help identify patients at risk and support more comprehensive management strategies in inflammatory arthritis.

Background/Objectives: Sacroiliac joint (SIJ) dysfunction is a common yet frequently underdiagnosed cause of chronic low back pain. This study aimed to compare the clinical effectiveness of ultrasound-guided corticosteroid and ozone injections in patients with chronic low back pain due to SIJ dysfunction. Methods: This comparative clinical study included 64 patients with chronic sacroiliac joint (SIJ) dysfunction who received ultrasound-guided SIJ injections with either corticosteroid (n = 31) or ozone (n = 33). Participants had a mean age of 45.0 ± 7.7 years, and the sex distribution was 42/22 (female/male). Pain intensity was assessed using the Numeric Rating Scale (NRS), disability using the Oswestry Disability Index (ODI), and quality of life using the Short Form-12 Physical (PCS) and Mental (MCS) Component Summary scores. Outcomes were evaluated at baseline, 3 months, and 6 months. Longitudinal changes were analyzed using two-way repeated-measures ANOVA (group × time) with Bonferroni-adjusted post hoc comparisons. Effect sizes were calculated using Cohen’s d. Normality and homoscedasticity were assessed (Shapiro–Wilk and Levene tests), and baseline comparisons were performed using appropriate parametric or non-parametric tests. Results: Both treatments significantly improved pain, disability, and quality of life at 3 months (p < 0.01). However, improvements were significantly greater and more durable in the ozone group across all outcomes at both 3 and 6 months (p < 0.01). At 6 months, between-group differences favored ozone for NRS (mean difference −2.81; Cohen’s d = −2.36), ODI (−6.05; d = −1.46), SF-12 PCS (+4.24; d = 1.24), and SF-12 MCS (+4.22; d = 0.83). A ≥50% pain reduction was achieved at 3 months in 97.0% of ozone-treated patients versus 45.2% of corticosteroid-treated patients (p < 0.01) and persisted at 6 months in 18.2% and 0% of patients, respectively (p < 0.05). The magnitude of improvement in the ozone group exceeded commonly reported Minimal Clinically Important Difference (MCID) thresholds for chronic low back pain outcomes, supporting clinical relevance. Conclusions: Ultrasound-guided ozone injection provided greater and more durable improvements in pain relief, functional status, and quality of life compared with corticosteroid injection in patients with SIJ dysfunction.