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Patients with gout adhere to curative treatment if informed appropriately: proof-of-concept observational study
Frances Rees1, Wendy Jenkins, M Doherty
1Academic Rheumatology, University of Nottingham, City Hospital, Nottingham, UK.
Insights
A nurse-led gout management program significantly improved patient outcomes. Over 90% of patients achieved target serum uric acid levels within a year, demonstrating effective urate-lowering therapy (ULT) adherence.
Area of Science:
- Rheumatology
- Clinical Medicine
- Patient Management
Background:
- Physicians often perceive gout patients as non-adherent to urate-lowering therapy (ULT).
- This perception may stem from a lack of comprehensive patient education and suboptimal management strategies.
Purpose of the Study:
- To evaluate the effectiveness of a multifaceted intervention for gout management.
- The intervention aimed to incorporate current guidelines, patient education, and optimal delivery in a specialist setting.
Main Methods:
- An observational study involving 106 patients with recurrent gout attacks.
- Participants received a nurse-led intervention including education, lifestyle advice, and ULT.
- The primary goal was to achieve serum uric acid (SUA) levels ≤360 µmol/l in at least 70% of patients after one year.
Main Results:
- 92% of participants achieved the target SUA level (≤360 µmol/l) at 12 months.
- 85% reached a stricter target of SUA <300 µmol/l.
- Significant improvements in pain were noted, as measured by the Short Form-36.
Conclusions:
- A nurse-led intervention combining education, lifestyle advice, and ULT is highly effective.
- This approach successfully achieves therapeutic targets in over 90% of gout patients.
- Patient understanding of gout and individualized management likely contribute to successful treatment adherence.
Introduction:
Many doctors believe that patients with gout are unwilling to receive urate-lowering therapy (ULT) and blame them for poor adherence to management.
Objective:
To test the effectiveness of a complex intervention for gout that incorporates key elements of current guidelines, including full patient information, delivered in an optimal setting (specialist hospital clinic).
Method:
Observational study of patients reporting ongoing attacks of gout recruited from primary care lists. 106 participants (94 men, 12 women; mean age 61 years) were enrolled in the study. Patients received a predominantly nurse-delivered intervention that included education, individualised lifestyle advice and appropriate ULT. The predefined goal was to achieve serum uric acid (SUA) levels≤360 micromol/l after 1 year in at least 70% of participants.
Results:
Of the 106 participants at baseline, 16% had tophi; mean (SD) baseline SUA was 456 (98) µmol/l. All participants agreed to joint aspiration to confirm gout and all wished to receive ULT. At 12 months, 92% of the 106 participants had achieved the therapeutic target (SUA≤360 µmol); 85% had SUA<300 µmol/l. Allopurinol was the most commonly used ULT, requiring a median dose of 400 mg daily to achieve the target. Improvements in Short Form-36 were observed (significant for pain) after 1 year.
Conclusion:
A predominantly nurse-led intervention including education, lifestyle advice and ULT can successfully achieve the recommended treatment target in more than 9 out of 10 patients. Full explanation and discussion about the nature of gout and its treatment options and individualisation of management probably account for this success.
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