The objectives of the present work were (1) to establish the prevalence of the abnormalities detected by magnetic resonance imaging (MRI) and ultrasonography (US); and (2) to compare these imaging techniques in detail. The study group consisted of 58 patients with symptomatic knee OA and 16 volunteer control subjects. Knee joint was evaluated for femoral condylar cartilage changes, effusion, synovial thickening and popliteal cysts using MRI and US. All knees with OA had cartilage abnormalities on US examinations and normal cartilage was detected in less than 3% of these knees by MRI. Majority of the knees with OA had effusion using US (70%) or MRI (85%). Synovial thickening observed on US (34%) and MRI (50%) were common in the knees with OA. Popliteal cysts were detected in 40% of the knees with OA using US and 35% using MRI. This study confirmed that there was a significant correlation between the MRI and US techniques for evaluating the cartilage and soft tissue changes in the patients with knee OA. There were more significant differences between the controls and the symptomatic knees which had Kellgren-Lawrence (K-L) grade 2 or more OA for the cartilage and soft tissue abnormalities on MRI and US. The prevalence of cartilage changes, effusion, synovial thickening and popliteal cyst using MRI and US were increased as the radiographic grade of OA increased. US examinations could be an alternative to initial evaluation tool to MRI in patients with knee OA.

In a Turkish League Against Rheumatism (TLAR) project, evidence-based recommendations for the management of knee osteoarthritis (OA) was developed for the first time in our country in 2012 (TLAR-2012). In accordance with developing medical knowledge and scientific evidence, recommendations were updated. The committee was composed of 22 physical medicine and rehabilitation specialists (4 have rheumatology subspeciality also) and an orthopaedic surgeon. Systematic literature search were applied on Pubmed, Embase, Cochrane and Turkish Medical Index for the dates between January the 1st 2012 and January the 29th of 2015. The articles were assessed for quality and classified according to hierarchy for the level of evidence, and the selected ones sent to committee members electronically. They were asked to develop new recommendations. In the meeting in 2015, the format of the recommendations was decided to be patient-based and considering the grade and the severity of the disease. By the discussion of the each item under the light of new evidences, the final recommendations were developed. Each item was voted electronically on a 10-cm visual analogue scale (VAS) and the strength of recommendation (SoR) was calculated. In the light of evidences, totally 11 titles of recommendations were developed; the first 7 were applicable to each patient in every stages of the disease, remaining were for defined specific clinical situations. The mean SoR value of the recommendations was between 7.44 and 9.93. TLAR-2012 recommendations were updated in a new format. We think that, present recommendations will be beneficial for the physicians who manage, as well as the patients who suffer from the disease.

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Further data pertaining to other countries would be interesting to uncover whether ethnic differences also affect cartilage thickness. Collaborative use of MSUS seems to be promising in this regard.

Flexor pollicis longus tendons seem to be thicker at the midthenar level in subjects who frequently use mobile phone texting. Because this increase in thickness parallels the number of messages per day, the authors believe that further studies are needed to elucidate whether such changes become problematic later on in life.

Amaç: Diz osteoartriti (OA) sık görülen ve neden olduğu ağrı ve sakatlık sonucunda sosyoekonomik yük bindiren bir hastalıktır. Türkiye Romatizma Araştırma ve Savaş Derneği (TRASD) OA tedavisi ile uğraşan hekimlere günlük klinik uygulamalarında yardımcı olmak amacıyla, uzman görüşleri ile desteklenmiş, ulusal "diz osteoartrit tedavisinde kanıta dayalı önerileri" hazırlamak için bir proje başlatmıştır. Objectives: Knee osteoarthritis (OA) is a common disease which causes pain, disability and great socioeconomic burden as a result. Turkish League Against Rheumatism (TLAR) initiated a project to prepare national, "evidence-based recommendations for the management of knee osteoarthritis" supported by expertopinion in order to assist the physicians who are interested in knee OA in their daily clinical practice. Gereç ve yöntemler: Materials and methods:The expert committee was composed of 25 academicians, 23 of whom were physical medicine and rehabilitation (PM&R) specialists (three also had rheumatology subspeciality) and two were orthopedic surgeons. At the first meeting, the previous guidelines were discussed, and 2008 Osteoarthritis Research Society International (OARSI) recommendations were decided to be taken as the fundamental template for national recommendations. Databases of the Pubmed, Embase, Cochrane, and Turkish Medical Index were used to search the literature, and this was carried out for the period between 2009-2010 for international publications since studies up to 2009 were present in the 2010 OARSI update. No limit was applied for searching of national publications. The selected relevant publications were graded according to evidence level and quality, and were sent to the members who were then asked to suggest propositions according to their experiences, knowledge, and review of the literature. After amalgamation and editing of new proposals, Delphi rounds were started. After five Delphi rounds, the propositions on which the members were in consensus, were discussed with regard to evidence and the "strength of recommendation" was determined by measuring on visual analog scale (VAS) for each proposal at the final meeting.Results: Nineteen propositions (one for general principles, nine for nonpharmacologic treatments, seven for pharmacologic treatments, and two for surgical treatments) were accepted as the "TLAR Evidence-Based Recommendations for the Management of Knee OA" in consensus as a result of Delphi rounds. Conclusion:Evidence-based recommendations for the management of knee OA were developed by TLAR for the first time in our country. The recommendations should be updated regularly according to new evidence and insights. It is expected that physicians who are interested in knee OA will benefit greatly from this report in their daily clinical practice.

We aimed to compare the efficacy of intra-articular injections of a lower molecular weight hyaluronan (LMW HA) (Ostenil) with a higher molecular weight viscosupplement (hylan G-F 20, Synvisc) in hip osteoarthritis. For this purpose, 43 patients (56 hips) with hip osteoarthritis with a visual analogue scale (VAS) pain score higher than 50/100, a Lequesne index greater than 6, and persistence of the pain for longer than 3 months despite all conservative methods were enrolled in the study and randomly assigned to two groups: 25 (32 hips) received LMW HA and the remaining 18 patients (24 hips) received hylan G-F 20. Three injections were administered once weekly to each patient under fluoroscopic guidance. During the 6-month follow-up period, the primary outcomes were assessed at the 1st, 3rd, and 6th month by VAS, WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index), and Lequesne index. The intra-articular injections produced a significant reduction in VAS, WOMAC, and Lequesne index scores in both groups. After three injections, improvement was prominent at the 1st month and maintained for 6 months in both groups. The percentage reduction was 38 and 40% (p<0.001) in VAS pain score, 43 and 40% in WOMAC (p<0.001), and 47 and 49% in Lequesne index (p<0.001) in the LMW HA and hylan G-F groups at the 6th month, respectively. However, there were no significant differences in outcomes between any of the measurements at the 1st, 3rd, and 6th month between the two groups (p>0.05). No systemic adverse effect was recorded. Local adverse effects consisting of pain and/or swelling were noted in 3 of 32 hips (9%) injected with LMW HA and in 3 of 24 hips (12.5%) injected with hylan G-F 20. In conclusion, both types of viscosupplementation produced a significant clinical improvement during the 6-month follow-up period. However, no significant difference was found in outcomes between higher and lower molecular weight hyaluronan.

The aim of the study was to evaluate the femoral cartilage thicknesses of hemiparetic patients after stroke using musculoskeletal ultrasonography and to determine whether there is any correlation between cartilage thicknesses and the clinical characteristics of the patients. Femoral cartilage thicknesses of both knees were measured in 87 (33 women, 54 men) hemiparetic patients. The mean age of the patients was 61.8 years (SD 11.1 years, range 32-87 years) and the mean duration of stroke was 12.3 months (SD 10.5 months, range 1-36 months). The outcome was measured in terms of motor recovery (Brunnstrom stages), spasticity (Modified Ashworth Scale), walking ability (Functional Ambulation Categories), and motor functioning (Functional Independence Measurement instrument). Ultrasonographic measurements were made axially from the suprapatellar window using linear probes while the patients' knees were held in maximum flexion. Three (midpoint) measurements were taken from both knees [lateral condyle (LFC), intercondylar area, and medial condyle (MFC)]. The mean cartilage thicknesses were found to be less on the paretic side (statistically significant only for LFC) when compared with the nonparetic side. Cartilage thickness values were found to be negatively correlated with the duration of immobilization (with paretic side LFC) and BMI (with both sides' MFC) and positively correlated with the Functional Independence Measurement motor score (with paretic side LFC) and the Functional Ambulation Categories scores (with both sides' LFC and MFC). Femoral cartilage is thinner on the paretic side in stroke patients. As the thickness values correlate with the duration of the disease and the ambulatory status of the patients, we suggest that early mobilization would be important in maintaining their cartilage integrity.