Background:We aimed to systematically review the effectiveness of healthcare behavioral and education interventions for gout patients on clinical outcomes.Methods:We searched multiple databases to identify trials or observational studies of educational or behavioral interventions in gout. Risk of bias was assessed with the Cochrane tool for randomized control trials (RCTs) and the Newcastle–Ottawa Scale for observational studies. We estimated odds ratios (ORs) for categorical and standardized mean difference (SMD) for continuous measures using a random-effects model.Results:Overall, eight (five RCTs and three observational) studies met the inclusion criteria and examined pharmacist-led interventions (n = 3), nurse-led interventions (n = 3) and primary care provider interventions (n = 2). Compared with the control intervention (usual care in most cases), a higher proportion of those in the educational/behavioral intervention arm achieved serum urate (SU) levels <6 mg/dl, 47.2% versus 23.8%, the OR was 4.86 [95% confidence interval (CI), 1.48, 15.97; 4 RCTs] with moderate quality evidence. Compared with the control intervention, a higher proportion of those in the educational/behavioral intervention arm were adherent to allopurinol, achieved at least a 2 mg/dl decrease in SU, achieved an SU < 5 mg/dl, had a reduction in the presence of tophi at 2 years, had improved quality of life as assessed with SF-36 physical component scores, had a higher knowledge about gout and higher patient satisfaction (moderate-low quality evidence).Conclusion:Educational and behavioral interventions can improve gout outcomes in the short-intermediate term. Randomized trials are needed to assess its impact on long-term gout outcomes.

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Background: To systematically review the diagnostic accuracy of salivary gland ultrasound in primary Sjögren’s syndrome (pSS). Methods: PubMed, Embase, CINAHL, Cochrane Central and Scopus and ClinicalTrials.gov were searched to identify diagnostic or validation studies in patients with pSS meeting the diagnostic criteria. A diagnostic test meta-analysis was performed using a bivariate model to calculate the pooled sensitivity, specificity, positive/negative likelihood ratios, and the diagnostic odds ratio. Meta-regression analyses were done for several pSS covariates. Results: Sixty-five studies met our criteria for the qualitative review. Fifty-four studies with a total of 6087 patients were included in the meta-analysis. Pooled sensitivity for salivary gland ultrasound was 80% [95% confidence interval (CI): 77–83%; I2 = 78%], and specificity was 90% (95% CI: 87–92%; I2 = 76%). The pooled positive and negative likelihood ratios were 8 (95% CI: 6.4–10) and 0.22 (95% CI: 0.19–0.25), respectively. The corresponding pooled diagnostic odds ratio (DOR) was 37 (95% CI: 28–48). Separate meta-regression models resulted in similar diagnostic estimates: (a) adjusted for mean age: sensitivity 81% (95% CI:77–84%; I2 = 99%) and specificity 90% (95% CI: 87–93%; I2 = 99%); (b) adjusted for mean disease duration, sensitivity 79% (95% CI:72–84%; I2 = 99%), and specificity 90% (89–94%; I2 = 99%). The diagnostic estimates were robust to sensitivity analyses by quality criteria, pSS diagnostic criteria and ultrasound scoring systems. Conclusion: Salivary gland ultrasound is a valuable modality for the diagnosis of Sjögren’s syndrome. It is plausible that salivary gland ultrasound can be used as an important criterion for the diagnosis of pSS.