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Performance of a supervised nurse-led outpatient clinic for difficult-to-manage gout patients at a tertiary center

Piroska Maurer1, Regina Herren2, Tobias Manigold3,4

  • 1Faculty of Medicine, University of Bern, Bern, Switzerland.

BMC Rheumatology
|June 4, 2026
PubMed

Insights

Nurse-led gout clinics effectively achieve serum urate targets in complex patients. Maintaining these targets requires ongoing education and potentially shorter follow-ups for optimal gout management.

Area of Science:

  • Rheumatology
  • Clinical Nursing
  • Pharmacology

Background:

  • Gout is a prevalent arthritis linked to significant morbidity and healthcare costs.
  • Many patients with gout remain undertreated despite available urate-lowering therapies (ULT).
  • Nurse-led interventions show promise in primary care but lack data in complex, multimorbid tertiary settings.

Purpose of the Study:

  • To assess the effectiveness of a supervised nurse-led gout clinic in achieving and maintaining serum urate (SU) targets.
  • To evaluate outcomes in a tertiary hospital cohort with severe or complex gout.
  • To provide data on nurse-led gout management in a challenging patient population.

Main Methods:

  • An observational study involving 69 patients with confirmed gout at a tertiary hospital.
  • Patients were assigned SU targets (≤300 µmol/L for severe gout, ≤360 µmol/L for non-severe gout).
  • Management involved an Advanced Practice Nurse for education and a rheumatologist for pharmacological treatment, with follow-ups at six and twelve months.

Main Results:

  • SU targets were achieved in 80% of severe gout regimens and 68% of non-severe gout regimens.
  • Flare rates and prophylaxis use were similar between groups.
  • At twelve months, 67% of severe gout patients and 88% of non-severe gout patients maintained SU targets; failures were often due to external treatment changes.

Conclusions:

  • Supervised nurse-led gout management is effective in achieving SU targets, even in difficult-to-manage tertiary cohorts.
  • Sustaining SU targets may necessitate shorter follow-up intervals.
  • Enhanced patient and healthcare provider education is crucial for maintaining treatment success.
Abstract

Keywords:
Difficult-to-manage goutGoutNurse-led managementTertiary careTransplant patients

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