Arthritis of the first metatarsophalangeal joint is not always gout: a prospective cohort study in primary care patients.

Objectives: Arthritis of the first metatarsophalangeal joint has been considered pathognomonic for gout, but it is unknown how frequently other forms of arthritis occur in this joint. The aims were to determine the validity of the general practitioner's clinical diagnosis using joint fluid analysis as the reference test, the prevalence of other diagnoses than gout, and the signs and symptoms that discriminate between gout and non-gout patients.

Methods: This prospective cohort study comprised primary care patients with monoarthritis of the first metatarsophalangeal joint.

Vascular outcomes in patients with screen-detected or clinically diagnosed type 2 diabetes: Diabscreen study follow-up.

Purpose: Screening guidelines for type 2 diabetes recommend targeting high-risk individuals. Our objective was to assess whether diagnosis of type 2 diabetes based on opportunistic targeted screening results in lower vascular event rates compared with diagnosis on the basis of clinical signs or symptoms.

Methods: In a prospective, nonrandomized, observational study, we enrolled patients aged 45 to 75 years from 10 family practices in the Netherlands with a new diagnosis of type 2 diabetes, detected either by (1) opportunistic targeted screening (n = 359) or (2) clinical signs or symptoms (n = 206).

A case-control study of determinants for the occurrence of gouty arthritis in heart failure patients.

Aims: Gouty arthritis is a frequent and disabling complication in heart failure patients. This study aimed to investigate which factors are associated with the occurrence of gouty arthritis in these patients.

Methods And Results: A case-control study was performed in heart failure patients (February 2007 to October 2009).

Use of diuretics and the risk of gouty arthritis: a systematic review.

Objective: To systematically review the literature investigating the relationship between use of diuretics and the risk of gouty arthritis.

Methods: PubMed (1950-October 2009), Embase (1974-October 2009), and the Cochrane Library (up to October 2009) were searched using keywords and MeSH terms diuretics, adverse effects, and gout. For this review, the technique of "best evidence synthesis" was used.

[Aftercare in oncology--greater role for the general practitioner].

Patients who undergo curative treatment for cancer continue to be medically monitored for a number of years. Scheduled aftercare, mainly aimed at early detection of locoregional cancer recurrences, distant metastases and secondary primary tumours, takes place chiefly in the second line, but is expected to shift to the first line. Figures from the Nijmegen Continuous Morbidity Registration show that an average (Dutch) general practitioner, caring for about 2500 patients, has in his practice 90 patients who have or have had cancer.