Abstract
BackgroundGout treatment is suboptimal despite available therapy, with low levels of initiation and persistence of urate-lowering therapy (ULT) in many patients.AimTo identify all interventions that have attempted to improve the uptake of ULT and analyse the clinical outcomes.Design & settingA systematic review of international articles published in English.MethodA systematic search was conducted through MEDLINE, Embase, CINAHL Plus, and Scopus databases to identify all studies on relevant interventions for gout. Interventions were included if they aimed to address patient adherence with serum urate (SU) level as an outcome. This included patient education, practitioner monitoring, medication titration, SU monitoring, and ongoing patient engagement and follow-up. Follow-up studies to original interventions and those with only an abstract available were included.ResultsTwenty articles met the inclusion criteria, describing outcomes of 18 interventions conducted in primary care settings: six nurse-led, five pharmacist-led, and seven multidisciplinary, multifaceted interventions. Improvement in SU levels was observed in all interventions. Nurse-led interventions were effective at empowering patients as they addressed illness perceptions and provided education, advice, and telephone follow-up. Pharmacist-led interventions primarily aimed to monitor patients, alter medication dosage, and provide automated telephone follow-up. Various multifaceted programmes involving a range of providers resulted in increased sustained use of urate-lowering medication.ConclusionA nurse-led approach focusing on patient understanding about gout is the most effective in achieving improved patient adherence, and lowered SU levels among patients. An intervention should include patient education and follow-up components.
Highlights
Gout is a common form of arthritis caused by hyperuricaemia and subsequent deposit of monosodium urate (MSU) crystals in the joints
Twenty articles met the inclusion criteria, describing outcomes of 18 interventions conducted in primary care settings: six nurse-led, five pharmacist-led, and seven multidisciplinary, multifaceted interventions
A nurse-led approach focusing on patient understanding about gout is the most effective in achieving improved patient adherence, and lowered serum urate (SU) levels among patients
Summary
Gout is a common form of arthritis caused by hyperuricaemia and subsequent deposit of monosodium urate (MSU) crystals in the joints. Gout flares are painful and cause disruption to employment and social activities. Gout has other long-term sequelae, including formation of tophi and joint damage. Gout flares are typically treated with non-steroidal anti-inflammatory drugs (NSAIDS), colchicine, and/or corticosteroids. Clinical guidelines recommend prevention of recurrent gout flares through treating the cause, with the use of medications such as allopurinol, febuxostat, and probenecid, which lower urate levels.[1,2] Achieving and maintaining a target SU level of
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