Eccentric training and static stretching exercises is superior to eccentric training alone to reduce pain and improve function in patients with patellar tendinopathy at the end of the treatment and at follow-up.

BackgroundThe diagnostic golden standard for gout is to detect monosodium urate (MSU) crystals in synovial fluid. While some gout classification criteria include this variable, most gout diagnoses are based on clinical features. This discrepancy between clinical practice and classification criteria can hinder gout epidemiological studies. Here, the objective was to validate gout diagnoses (International Classification of Diseases (ICD)-10 gout codes) in primary and secondary care relative to five classification criteria (Rome, New York, ARA, Mexico, and Netherlands). The frequency with which MSU crystal identification was used to establish gout diagnosis was also determined.MethodsIn total, 394 patients with ≥1 ICD-10 gout diagnosis between 2009 and 2013 were identified from the medical records of two primary care centers (n = 262) and one secondary care center (n = 132) in Gothenburg, Sweden. Medical records were assessed for all classification criteria.ResultsPrimary care patients met criteria cutoffs more frequently when ≥2 gout diagnoses were made. Even then, few primary care patients met the Rome and New York cutoffs (19 % and 8 %, respectively). The ARA, Mexico, and Netherlands cutoffs were met more frequently by primary care patients with ≥2 gout diagnoses (54 %, 81 %, and 80 %, respectively). Mexico and Netherlands cutoffs were met more frequently by the rheumatology department patients (80 % and 71 %, respectively), even when patients with only 1 gout diagnosis were included. Analysis of MSU crystals served to establish gout diagnoses in only 27 % of rheumatology department and 2 % of primary care cases.ConclusionsIf a patient was deemed to have gout at ≥2 primary care center or ≥1 rheumatology-center visits according to an ICD-10 gout code, the positive predictive value of this variable in relation with the Mexico and Netherlands classification criteria was ≥80 % for both primary care and rheumatology care settings in Sweden. MSU crystal identification was rarely used to establish gout diagnosis.Electronic supplementary materialThe online version of this article (doi:10.1186/s12891-015-0614-2) contains supplementary material, which is available to authorized users.

Supervised exercise programme is superior to home exercise programme to reduce pain and improve function in patients with LET at the end of the treatment and at the follow-up. Further research is needed to confirm our results.

The results suggest that the combination of an exercise program with LLLT or polarized polychromatic non-coherent light is an adequate treatment for patients with LET. Further research to establish the relative and absolute effectiveness of such a treatment approach is needed.

BackgroundTo diagnose gout, the golden standard is detection of monosodium urate (MSU) crystals in synovial fluid [1,2]. However, while some gout classification criteria include this variable, most gout diagnoses are based on clinical features [3,4]. This discrepancy between clinical practice and classification criteria hampers gout epidemiological studies.ObjectivesThe objective was to validate gout diagnoses (ICD-10 gout codes) in primary care (PC) and secondary care relative to five classification criteria (Rome [5], New York [6], ARA [7], Mexico [8], and Netherlands [9]). The frequency with which MSU crystal identification was used to establish a gout diagnosis was also determined.MethodsIn total, 394 patients with ≥1 ICD-10 gout diagnoses in 2009–2013 in Gothenburg, Sweden were identified from medical records of two PCs (n=262) and one secondary care center (n=132). Medical records were assessed for all classification criteria.ResultsPC patients met criteria cut-offs more frequently when ≥2 gout diagnoses were made. However, even then, few PC patients met the Rome and New York cut-offs (19% and 8%, respectively). ARA, Mexico, and Netherlands cut-offs were met more frequently by PC patients with ≥2 gout diagnoses (54%, 81%, and 80%, respectively). Mexico and Netherlands cut-offs were met frequently by the rheumatology department patients even when patients with only 1 gout diagnosis were included (80% and 71%, respectively). MSU crystal analysis served to establish gout diagnosis in only 27% and 2% of rheumatology department and PC cases, respectively.ConclusionsIf a patient is deemed to have gout when ≥2 PC or ≥1 rheumatology-center visits associate with an ICD-10 gout code, the positive predictive value of this variable relative to the Mexico and Netherlands classification criteria was ≥80% in both PC and rheumatology care settings in Sweden. MSU crystal identification was rarely used to establish gout diagnoses.ReferencesMcCarty DJ et al: Identification of urate crystals in gouty synovial fluid. Ann Intern Med 1961, 54:452-460.Pascual E et al: Synovial fluid analysis for diagnosis of intercritical gout. Ann Intern Med 1999, 131(10):756-759.Choi HK et al: Alcohol intake and risk of incident gout in men: a prospective study. Lancet 2004, 363(9417):1277-1281.Choi HK et al: Obesity, weight change, hypertension, diuretic use, and risk of gout in men: the health professionals follow-up study. Arch Intern Med 2005, 165(7):742-748.Kellgren J H JM et al: The epidomiology of chronic rheumatism. Oxford: Blackwell Scientific 1963.Decker J: Report from the subcommittee on diagnostic criteria for gout. In: Bennett PH, Wood PHN, eds. Population studies of the rheumatic diseases. Proceedings of the Third International Symposium, New York, June 5-10, 1966. Amsterdam: Excerpta Medica Foundation, 1968, 1968:385-387.Wallace SL et al: Preliminary criteria for the classification of the acute arthritis of primary gout. Arthritis Rheum 1977, 20(3):895-900.Pelaez-Ballestas I et al: Diagnosis of chronic gout: evaluating the american...