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08-03-2018 | Gout | Review | Article

Are Doctors the Best People to Manage Gout? Is There a Role for Nurses and Pharmacists?

Journal: Current Rheumatology Reports

Authors: Zahira Latif, Abhishek Abhishek

Publisher: Springer US

Abstract

Purpose of Review

To discuss alternate models of long-term gout management

Recent Findings

Nurse-led care of gout appears to improve the uptake of and adherence to urate-lowering treatment in a research setting. Less impressive improvements were achieved with pharmacist-led remote management of gout; however, both strategies were more effective than usual primary care provider management of gout.

Summary

Individualised education about gout, patient involvement in decision-making, and access to trained support in managing side-effects and gout flares can improve the uptake of fine and adherence to urate-lowering treatment. This may be best achieved with nurse-led care of gout. However, further research is required to evaluate if the model of nurse-led care of gout can be implemented in routine clinical practice and in different healthcare systems.

• Kuo C-F, Grainge MJ, Mallen C, Zhang W, Doherty M. Rising burden of gout in the UK but continuing suboptimal management: a nationwide population study. Ann Rheum Dis. 2014;74(4):661–7. https://doi.org/10.1136/annrheumdis-2013-204463. Epidemiology of gout is described in this study CrossRefPubMedPubMedCentral

Juraschek SP, Miller ER 3rd, Gelber AC. Body mass index, obesity, and prevalent gout in the United States in 1988–1994 and 2007–2010. Arthritis Care & Research. 2013;65(1):127–32. https://doi.org/10.1002/acr.21791.CrossRef

Richette P, Bardin T. Gout. Lancet (London, England). 2010;375(9711):318–28. https://doi.org/10.1016/s0140-6736(09)60883-7.CrossRef

Andres M, Quintanilla MA, Sivera F, Sanchez-Paya J, Pascual E, Vela P, et al. Silent monosodium urate crystal deposits are associated with severe coronary calcification in asymptomatic hyperuricemia: an exploratory study. Arthr Rheumatol= (Hoboken, NJ). 2016;68(6):1531–9. https://doi.org/10.1002/art.39581.

De Miguel E, Puig JG, Castillo C, Peiteado D, Torres RJ, Martin-Mola E. Diagnosis of gout in patients with asymptomatic hyperuricaemia: a pilot ultrasound study. Ann Rheum Dis. 2012;71(1):157–8. https://doi.org/10.1136/ard.2011.154997. CrossRefPubMed

Abhishek A, Roddy E, Doherty M. Gout—a guide for the general and acute physicians. Clin Med (Lond). 2017;17(1):54–9. https://doi.org/10.7861/clinmedicine.17-1-54.CrossRef

• Abhishek A, Valdes AM, Zhang W, Doherty M. Association of serum uric acid and disease duration with frequent gout attacks: a case-control study. Arthritis care & research. 2016;68(10):1573–7. https://doi.org/10.1002/acr.22855. Longer disease duration and higher serum urate assiciates with gout floves CrossRef

Elliot AJ, Cross KW, Fleming DM. Seasonality and trends in the incidence and prevalence of gout in England and Wales 1994–2007. Ann Rheum Dis. 2009;68(11):1728–33. https://doi.org/10.1136/ard.2008.096693. CrossRefPubMed

Robinson PC, Merriman TR, Herbison P, Highton J. Hospital admissions associated with gout and their comorbidities in New Zealand and England 1999–2009. Rheumatol (Oxford, England). 2013;52(1):118–26. https://doi.org/10.1093/rheumatology/kes253. CrossRef

10.

Parsons S, Ingram, M., Clarke-Cornwell, M. A., Symmons, D. P. A heavy burden. In: A heavy burden. The University of Manchester, Manchester. 2011. Accessed 23/05/2017 2017.

11.

•• Abhishek A, Jenkins W, La-Crette J, Fernandes G, Doherty M. Long-term persistence and adherence on urate-lowering treatment can be maintained in primary care-5-year follow-up of a proof-of-concept study. Rheumatol (Oxford, England). 2017;56(4):529–33. https://doi.org/10.1093/rheumatology/kew395. Demonstrates long-term adherence and persistence of urate lowering treatment

12.

Rees F, Jenkins W, Doherty M. Patients with gout adhere to curative treatment if informed appropriately: proof-of-concept observational study. Ann Rheum Dis. 2013;72(6):826–30. https://doi.org/10.1136/annrheumdis-2012-201676.CrossRefPubMed

13.

• Kuo CF, Grainge MJ, Mallen C, Zhang W, Doherty M. Eligibility for and prescription of urate-lowering treatment in patients with incident gout in England. JAMA. 2014;312(24):2684–6. https://doi.org/10.1001/jama.2014.14484. Demonstrates poor urate lowering prescription rates in UK gout patients CrossRefPubMed

14.

•• Kiltz U, Smolen J, Bardin T, Cohen Solal A, Dalbeth N, Doherty M, et al. Treat-to-target (T2T) recommendations for gout. Ann Rheum Dis. 2017;76(4):632–8. https://doi.org/10.1136/annrheumdis-2016-209467. Treat to target recommendation for gout CrossRefPubMed

15.

Jordan KM, Cameron JS, Snaith M, Zhang W, Doherty M, Seckl J, et al. British Society for Rheumatology and British Health Professionals in Rheumatology guideline for the management of gout. Rheumatol (Oxford, England). 2007;46(8):1372–4. https://doi.org/10.1093/rheumatology/kem056a.CrossRef

16.

Kanbay M, Huddam B, Azak A, Solak Y, Kadioglu GK, Kirbas I, et al. A randomized study of allopurinol on endothelial function and estimated glomular filtration rate in asymptomatic hyperuricemic subjects with normal renal function. Clin J Am Soc Nephrol : CJASN. 2011;6(8):1887–94. https://doi.org/10.2215/cjn.11451210.CrossRefPubMedPubMedCentral

17.

Chen JH, Lan JL, Cheng CF, Liang WM, Lin HY, Tsay GJ, et al. Effect of urate-lowering therapy on the risk of cardiovascular disease and all-cause mortality in patients with gout: a case-matched cohort study. J Rheumatol. 2015;42(9):1694–701. https://doi.org/10.3899/jrheum.141542.CrossRefPubMed

18.

Chen JH, Lan JL, Cheng CF, Liang WM, Lin HY, Tsay GJ, et al. Effect of urate-lowering therapy on all-cause and cardiovascular mortality in hyperuricemic patients without gout: a case-matched cohort study. PLoS One. 2015;10(12):e0145193. https://doi.org/10.1371/journal.pone.0145193.CrossRefPubMedPubMedCentral

19.

Joo K, Kwon SR, Lim MJ, Jung KH, Joo H, Park W. Prevention of comorbidity and acute attack of gout by uric acid lowering therapy. J Korean Med Sci. 2014;29(5):657–61. https://doi.org/10.3346/jkms.2014.29.5.657.CrossRefPubMedPubMedCentral

20.

Larsen KS, Pottegard A, Lindegaard HM, Hallas J. Effect of allopurinol on cardiovascular outcomes in hyperuricemic patients: a cohort study. Am J Med. 2016;129(3):299–306 e2. https://doi.org/10.1016/j.amjmed.2015.11.003.CrossRefPubMed

21.

Xin W, Mi S, Lin Z. Allopurinol therapy improves vascular endothelial function in subjects at risk for cardiovascular diseases: a meta-analysis of randomized controlled trials. Cardiovasc Ther. 2016;34(6):441–9. https://doi.org/10.1111/1755-5922.12215.CrossRefPubMed

22.

Terawaki H, Nakayama M, Miyazawa E, Murata Y, Nakayama K, Matsushima M, et al. Effect of allopurinol on cardiovascular incidence among hypertensive nephropathy patients: the Gonryo study. Clin Exp Nephrol. 2013;17(4):549–53. https://doi.org/10.1007/s10157-012-0742-z.CrossRefPubMed

23.

Singh JA, Ramachandaran R, Yu S, Curtis JR. Allopurinol use and the risk of acute cardiovascular events in patients with gout and diabetes. BMC Cardiovasc Disord. 2017;17(1):76. https://doi.org/10.1186/s12872-017-0513-6. CrossRefPubMedPubMedCentral

24.

Kanji T, Gandhi M, Clase CM, Yang R. Urate lowering therapy to improve renal outcomes in patients with chronic kidney disease: systematic review and meta-analysis. BMC Nephrol. 2015;16(1):58. https://doi.org/10.1186/s12882-015-0047-z.CrossRefPubMedPubMedCentral

25.

Bose B, Badve SV, Hiremath SS, Boudville N, Brown FG, Cass A, et al. Effects of uric acid-lowering therapy on renal outcomes: a systematic review and meta-analysis. Nephrol Dialysis Trans : Off Publ Eur Dialysis Trans Assoc-Eur Renal Assoc. 2014;29(2):406–13. https://doi.org/10.1093/ndt/gft378.CrossRef

26.

Spencer K, Carr A, Doherty M. Patient and provider barriers to effective management of gout in general practice: a qualitative study. Ann Rheum Dis. 2012;71(9):1490–5. https://doi.org/10.1136/annrheumdis-2011-200801. CrossRefPubMed

27.

• Chandratre P, Mallen CD, Roddy E, Liddle J, Richardson J. “You want to get on with the rest of your life”: a qualitative study of health-related quality of life in gout. Clin Rheumatol. 2016;35(5):1197–205. https://doi.org/10.1007/s10067-015-3039-2. Qualitative study of impact of gout on patients CrossRefPubMed

28.

Te Karu L, Bryant L, Elley CR. Maori experiences and perceptions of gout and its treatment: a kaupapa Maori qualitative study. J Prim Health Care. 2013;5(3):214–22.

29.

• Duyck SD, Petrie KJ, Dalbeth N. “You don’t have to be a drinker to get gout, but it helps”: a content analysis of the depiction of gout in popular newspapers. Arthritis Care & Research. 2016;68(11):1721–5. https://doi.org/10.1002/acr.22879. Qualitative study of impact of gout on patients CrossRef

30.

• Vaccher S, Kannangara DR, Baysari MT, Reath J, Zwar N, Williams KM, et al. Barriers to care in gout: from prescriber to patient. J Rheumatol. 2016;43(1):144–9. https://doi.org/10.3899/jrheum.150607. Qualitative study of gout patients and their doctors CrossRefPubMed

31.

•• Abhishek A, Doherty M. Education and non-pharmacological approaches for gout. Rheumatology. 2018;57(suppl_1):i51–i8. https://doi.org/10.1093/rheumatology/kex421. Describes current state of mis-information about gout CrossRefPubMed

32.

Dalbeth N, House ME, Aati O, Tan P, Franklin C, Horne A, et al. Urate crystal deposition in asymptomatic hyperuricaemia and symptomatic gout: a dual energy CT study. Ann Rheum Dis. 2015;74(5):908–11. https://doi.org/10.1136/annrheumdis-2014-206397.CrossRefPubMed

33.

Carter JD, Patelli M, Anderson SR, Prakash N, Rodriquez EJ, Bateman H, et al. An MRI assessment of chronic synovial-based inflammation in gout and its correlation with serum urate levels. Clin Rheumatol. 2015;34(2):345–51. https://doi.org/10.1007/s10067-014-2644-9.CrossRefPubMed

34.

Popovich I, Lee AC, Doyle A, McHaffie A, Clarke A, Reeves Q, et al. A comparative MRI study of cartilage damage in gout versus rheumatoid arthritis. J Med Imagin Radiat Oncol. 2015;59(4):431–5. https://doi.org/10.1111/1754-9485.12306.CrossRef

35.

Fisher MC, Rai SK, Lu N, Zhang Y, Choi HK. The unclosing premature mortality gap in gout: a general population-based study. Ann Rheum Dis. 2017;76(7):1289–94. https://doi.org/10.1136/annrheumdis-2016-210588.CrossRefPubMed

36.

Juraschek SP, Gelber AC, Choi HK, Appel LJ, Miller ER 3rd. Effects of the dietary approaches to stop hypertension (DASH) diet and sodium intake on serum uric acid. Arthritis & Rheumatology (Hoboken, NJ). 2016;68(12):3002–9. https://doi.org/10.1002/art.39813.CrossRef

37.

Kanbara A, Miura Y, Hyogo H, Chayama K, Seyama I. Effect of urine pH changed by dietary intervention on uric acid clearance mechanism of pH-dependent excretion of urinary uric acid. Nutr J. 2012;11:39. https://doi.org/10.1186/1475-2891-11-39.CrossRefPubMedPubMedCentral

38.

Richette P, Doherty M, Pascual E, Barskova V, Becce F, Castañeda-Sanabria J, et al. 2016 updated EULAR evidence-based recommendations for the management of gout. Ann Rheum Dis. 2016;76(1):29–42. https://doi.org/10.1136/annrheumdis-2016-209707.CrossRefPubMed

39.

De Vera MA, Marcotte G, Rai S, Galo JS, Bhole V. Medication adherence in gout: a systematic review. Arthritis care & Res. 2014;66(10):1551–9. https://doi.org/10.1002/acr.22336.CrossRef

40.

Briesacher BA, Andrade SE, Fouayzi H, Chan KA. Comparison of drug adherence rates among patients with seven different medical conditions. Pharmacotherapy. 2008;28(4):437–43. https://doi.org/10.1592/phco.28.4.437.CrossRefPubMedPubMedCentral

41.

•• Doherty M, Jenkins W, Richardson H, Abhishek A, Ashton D, Barclay C, et al. OP0268 nurse-led care versus general practitioner care of people with gout: a UK community-based randomised controlled trial. Ann Rheum Dis. 2017;76(Suppl 2):167. https://doi.org/10.1136/annrheumdis-2017-eular.5006. 2 year RCT of nurse led versus usual caneg gout

42.

•• Goldfien RD, Ng MS, Yip G, Hwe A, Jacobson A, Pressman A, et al. Effectiveness of a pharmacist-based gout care management programme in a large integrated health plan: results from a pilot study. BMJ Open. 2014;4(1):e003627. https://doi.org/10.1136/bmjopen-2013-003627. Describes pharmacist management of gout CrossRefPubMedPubMedCentral

43.

•• Goldfien R, Pressman A, Jacobson A, Ng M, Avins A. A pharmacist-staffed virtual gout management clinic for achieving target serum uric acid levels: a randomized clinical trial. Permanente J. 2016;20(3):18–23. https://doi.org/10.7812/tpp/15-234.. RCT of remote monitoring and treatment of gout by pharmacist

44.

•• Mikuls, TR CT, Rashid N, Levy GD, Kerimian A, Low K, Coburn B, Redden DT, Bridges SL Jr., Saag KG, Curtis JR. A pragmatic cluster-randomized controlled trial of an automated, pharmacy-based intervention to optimize allopurinol therapy in gout [abstract]. Arthritis Rheumatol 2015;67(Suppl 10). Ongoing cluster RCT of gout management

45.

•• Fields TR, Rifaat A, Yee AMF, Ashany D, Kim K, Tobin M, et al. Pilot study of a multidisciplinary gout patient education and monitoring program. Semin Arthritis Rheum. 2017;46(5):601–8. https://doi.org/10.1016/j.semarthrit.2016.10.006. Patient education improves uptake of ULT CrossRefPubMed

Medicine Matters Rheumatology

Abstract

Purpose of Review

Recent Findings

Summary