Advertisement

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

  • Zahira Latif
  • Abhishek Abhishek
Crystal Arthritis (L Stamp, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Crystal Arthritis

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.

Keywords

Gout Urate-lowering treatment Nurse-led care Pharmacist-led care 

Notes

Compliance with Ethical Standards

Conflicts of Interest

Dr. Abhishek has received departmental research grants from AstraZeneca and Oxford Immunotech and has received speaker fees from Menarini pharmaceuticals.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    • 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 CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    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.CrossRefGoogle Scholar
  3. 3.
    Richette P, Bardin T. Gout. Lancet (London, England). 2010;375(9711):318–28.  https://doi.org/10.1016/s0140-6736(09)60883-7.CrossRefGoogle Scholar
  4. 4.
    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.Google Scholar
  5. 5.
    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. CrossRefPubMedGoogle Scholar
  6. 6.
    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.CrossRefGoogle Scholar
  7. 7.
    • 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 CrossRefGoogle Scholar
  8. 8.
    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. CrossRefPubMedGoogle Scholar
  9. 9.
    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. CrossRefGoogle Scholar
  10. 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.Google Scholar
  11. 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 Google Scholar
  12. 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.CrossRefPubMedGoogle Scholar
  13. 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 CrossRefPubMedGoogle Scholar
  14. 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 CrossRefPubMedGoogle Scholar
  15. 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.CrossRefGoogle Scholar
  16. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 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.CrossRefPubMedGoogle Scholar
  18. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  19. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 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.CrossRefPubMedGoogle Scholar
  21. 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.CrossRefPubMedGoogle Scholar
  22. 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.CrossRefPubMedGoogle Scholar
  23. 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. CrossRefPubMedPubMedCentralGoogle Scholar
  24. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  25. 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.CrossRefGoogle Scholar
  26. 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. CrossRefPubMedGoogle Scholar
  27. 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 CrossRefPubMedGoogle Scholar
  28. 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.Google Scholar
  29. 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 CrossRefGoogle Scholar
  30. 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 CrossRefPubMedGoogle Scholar
  31. 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 CrossRefPubMedGoogle Scholar
  32. 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.CrossRefPubMedGoogle Scholar
  33. 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.CrossRefPubMedGoogle Scholar
  34. 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.CrossRefGoogle Scholar
  35. 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.CrossRefPubMedGoogle Scholar
  36. 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.CrossRefGoogle Scholar
  37. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  38. 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.CrossRefPubMedGoogle Scholar
  39. 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.CrossRefGoogle Scholar
  40. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  41. 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 Google Scholar
  42. 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 CrossRefPubMedPubMedCentralGoogle Scholar
  43. 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 Google Scholar
  44. 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 Google Scholar
  45. 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 CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Academic RheumatologyUniversity of Nottingham, Nottingham City HospitalNottinghamUK

Personalised recommendations