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Much to the liking of many geographers, Forbes Magazine’s contributor and professor in meteorology at the University of Georgia, J. Marshall Shepherd, wrote in early March 2020 an op‐ed titled ‘Why Geography is a key part of fighting the COVID‐19 Coronavirus outbreak’. In Wired, David Wolman (2020) wrote how the pandemic is redefining our relationship with space in a contribution titled ‘Amid a Pandemic, Geography Returns with a Vengeance’. Notwithstanding the many challenges that the Covid‐19 pandemic poses, both in our private lives and in our professional activities, it offers a great opportunity for analysis through a geographic lens. Geographical knowledge and geospatial data, perhaps best exemplified by the widely used Johns Hopkins University COVID‐19 tracking website, have already proven to be vital for understanding the pandemic’s reach. The uneven distribution of the virus across and within countries raises inherently geographic questions regarding the political, economic, financial, socio‐cultural and demographic dimensions of the pandemic. The aim of this special issue of Tijdschrift voor Economische en Sociale Geografie (TESG) is to present the initial investigations of geographers and socio‐spatial scientists into the emerging spaces of the effects of the COVID‐19 pandemic. Following a call, we have received well over 40 papers, thereby exceeding our expectations. After internal and external review of the papers we here present the papers that were selected for publication. We are thankful to the reviewers who provided fast, yet detailed, feedback on the papers. In addition, we would like to thank Grace Ong, Senior Journals Publishing Editor at Wiley, and Noel Valdivia, Production Editor, for their support in the publication of this special issue. The papers in this special issue present an interesting geographical mix (with case studies from Asia, Europe and the North America) as well as a variety of methodological approaches towards understanding the spatial manifestations and variegated geographic impact of the pandemic. Furthermore, they well represent the different thematic fields in geography. The editors of TESG welcome more papers on the consequences of the COVID‐19 pandemic, which we will have reviewed as we do with any other paper. We will not be able to fast‐track new submissions but we will publish new papers online in ‘Early View’ soon after they have been accepted for publication. Future papers on COVID‐19 will also be added to a Virtual Special Issue, which will consist of all papers published in this issue together with new papers on the geography of the pandemic. As much as possible we aim for the open access publication of these papers. The papers in this special issue are grouped by theme and in the remainder of this editorial we will briefly introduce these different themes.

Objective: To examine the performance of ultrasound (US) for the diagnosis of gout using the presence of monosodium urate monohydrate (MSU) crystals as the gold standard. Methods: We analyzed data from the Study for Updated Gout Classification Criteria (SUGAR), a large, multicenter observational cross-sectional study of consecutive subjects with at least 1 swollen joint who conceivably may have gout. All subjects underwent arthrocentesis; cases were subjects with confirmed MSU crystals. Rheumatologists or radiologists who were blinded with regard to the results of the MSU crystal analysis performed US on 1 or more clinically affected joints. US findings of interest were double contour sign, tophus, and snowstorm appearance. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated. Multivariable logistic regression models were used to examine factors associated with positive US results among subjects with gout. Results: US was performed in 824 subjects (416 cases and 408 controls). The sensitivity, specificity, PPV, and NPV for the presence of any 1 of the features were 76.9%, 84.3%, 83.3%, and 78.2%, respectively. Sensitivity was higher among subjects with a disease duration of ≥2 years and among subjects with subcutaneous nodules on examination (suspected tophus). Associations with a positive US finding included suspected clinical tophus (odds ratio [OR] 4.77 [95% confidence interval (95% CI) 2.23–10.21]), any abnormality on plain radiography (OR 4.68 [95% CI 2.68–8.17]), and serum urate level (OR 1.31 [95% CI 1.06–1.62]). Conclusion: US features of MSU crystal deposition had high specificity and high PPV but more limited sensitivity for early gout. The specificity remained high in subjects with early disease and without clinical signs of tophi. (Less)

Objective To identify the best-performing survey definition of gout from items commonly available in epidemiologic studies. Methods Survey definitions of gout were identified from 34 epidemiologic studies contributing to the Global Urate Genetics Consortium (GUGC) genome-wide association study. Data from the Study for Updated Gout Classification Criteria (SUGAR) were randomly divided into development and test data sets. A data-driven case definition was formed using logistic regression in the development data set. This definition, along with definitions used in GUGC studies and the 2015 American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) gout classification criteria were applied to the test data set, using monosodium urate crystal identification as the gold standard. Results For all tested GUGC definitions, the simple definition of “self-report of gout or urate-lowering therapy use” had the best test performance characteristics (sensitivity 82%, specificity 72%). The simple definition had similar performance to a SUGAR data-driven case definition with 5 weighted items: self-report, self-report of doctor diagnosis, colchicine use, urate-lowering therapy use, and hyperuricemia (sensitivity 87%, specificity 70%). Both of these definitions performed better than the 1977 American Rheumatism Association survey criteria (sensitivity 82%, specificity 67%). Of all tested definitions, the 2015 ACR/EULAR criteria had the best performance (sensitivity 92%, specificity 89%). Conclusion A simple definition of “self-report of gout or urate-lowering therapy use” has the best test performance characteristics of existing definitions that use routinely available data. A more complex combination of features is more sensitive, but still lacks good specificity. If a more accurate case definition is required for a particular study, the 2015 ACR/EULAR gout classification criteria should be considered.

Objective Severe pain in patients with knee osteoarthritis (OA) hampers the ability to exercise. A protocol for the standardized optimization of analgesics in combination with exercise therapy was developed. The purpose of this protocol was to reduce pain, thereby allowing the patient to participate in exercise therapy. The objective of the present study was to evaluate the feasibility and outcome of the protocol. Methods Forty-nine patients with knee OA and severe knee pain (numerical rating scale for pain ≥7) were included. Analgesics were prescribed following an incremental protocol. After 6 weeks, a 12-week exercise therapy program was added. Information about analgesic use and exercise therapy content was recorded. Knee pain and activity limitations were assessed at baseline, after 6 weeks, and after 18 weeks. Results Statistically significant improvements in pain and activity limitations were found in intent-to-treat analysis after 6 weeks of analgesic use and after the intervention was completed. Mean improvements from baseline were 30% (P < 0.001) for pain and 17% (P < 0.001) for activity limitations after the intervention was completed. Seventy-eight percent of the patients were able to exercise according to the protocol. In these patients, exercise therapy following 6 weeks of analgesic use resulted in a further improvement of activity limitations of 10% (P = 0.004). Conclusion The combined intervention of standardized analgesic prescription and exercise therapy allows most patients with knee OA and severe pain to participate in exercise therapy, leading to reduction of pain and activity limitations. These promising results need to be confirmed in a randomized controlled trial.