Knee osteoarthritis (OA) is one of the most common forms of joint disease, affecting an increasing number of people worldwide. Latest data suggests that inflammation plays a critical role in the pathogenesis of OA. There are a number of inflammatory markers like cytokins and cartilage degradation products that can be used as indicators in OA. Blood neutrophil-lymphocyte ratio (NLR) is a simple non-invasive and cost-effective marker of inflammation in various systemic diseases, but it has not been investigated in OA yet. The aim of the present study was to compare blood NLR levels in patients with severe - Kellgren and Lawrence (KL) grade 4 - knee OA and mild to moderate - KL grades 1-3 - knee OA. A total of 176 patients with knee OA were included in this cross-sectional study. KL grading was done according to the two-view (antero-posterior and lateral) plain radiography of both knees. Demographic characteristics, blood neutrophil, lymphocyte and platelet counts, erythrocyte sedimentation rate, and C-reactive protein were recorded. Blood NLR levels were calculated. In the severe knee OA group, blood NLR levels were found to be elevated as compared to the mild to moderate knee OA group. A blood NLR of ≥2.1 was taken as the cutoff based upon the receiver operating characteristics (roc). In the roc curve analysis, blood NLR ≥ 2.1 had 50 % sensitivity and 77 % specificity in predicting severe knee OA. In multivariate analysis, age and blood NLR ≥ 2.1 emerged as independent predictors of severe knee OA. The results of the present study, for the first time in the literature, suggests blood NLR as a novel and promising inflammatory marker indicating the severity of knee OA.

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Ö zçakar L, Onat S $ S $ , Gü rçay E, Kara M: Are blind injections ethical or historical? Think twice with ultrasound. Am J Phys Med Rehabil 2016;95:158Y160.Indai ly musculoskeletal practice, a wide range of injections is commonplace and 0894-9115/16/9502-0158

The aim of this study is to determine the effectiveness of balneotherapy plus physical therapy versus only physical therapy in patients with chronic low back pain. In this trial, 81 patients with low back pain were followed up in two groups. Patients in group I (n = 44) were treated with physical therapy alone. Patients in group II (n = 37) were treated with balneotherapy in addition to the same physical therapy protocol in group I. Patients in both groups were given a home-based standardized exercise program. The following parameters were measured: visual analog scale (0-10 cm), fingertip-to-floor distance (cm), Oswestry Disability Index, and Short Form 36 quality of life scale. First evaluations were done at the time of enrollment, and second evaluations were done after accomplishment of a 3-week treatment program. There were no significant differences between the two groups for the sociodemographic features. All of the measured parameters improved in both groups. However, improvements in pain, functionality, and quality of life scores were found to be superior in the balneotherapy plus physical therapy group. For the patients with chronic low back pain, balneotherapy plus physical therapy is more effective, compared to physical therapy alone.

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