Background Urate lowering therapy (ULT) can effectively reduce serum urate level (SUA) and flares for gout, thereby minimizing progressive joint damage. Despite advances in therapies for gout and the publication of international guidelines, studies repeatedly showed that many patients remained undertreated worldwide. To help achieving treatment targets for gout, a rheumatology nurse follow-up programme (RNFP) was set up to provide patients with comprehensive education and telephone follow-up to monitor the disease control, treatment adherence and occurrence of adverse drug effects. Appropriate and timely intervention and counseling would be given to patients who were found to have adverse drug effects or treatment non-concordance.
Objectives The objectives of this study were to evaluate the effectiveness of RNFP in achieving the desired SUA for patients taking ULT and its role in detecting adverse drug effects and treatment concordance problems.
Methods This was a retrospective, observational study in a regional hospital in Hong Kong serving predominantly Southern Chinese. Patients with gouty arthritis with or without tophi requiring initiation or titration of ULT (allopurinol, probenecid or febuxostat) were recruited into the RNFP by rheumatologists. Patient profiles, SUA at the time of recruitment and end of study, incidents of adverse drug effects and drug non-concordance were recorded. The primary outcome was the achievement of target SUA of <0.3 mmol/L and <0.36 mmol/L for gouty arthritis patients with and without tophi respectively at study end.
Results From May 2011 to December 2013, 89 patients were recruited into the programme. Fifty three were male. Mean age was 66 years (33-93 years). Eighteen patients had tophi. Duration of nurse follow-up for each patient was 18.7 weeks (1.4 – 120.1weeks). Number of patients using allopurinol, febuxostat and probenecid were 81, 13 and 11 respectively. The mean pre-recruitment SUA was 0.529 mmol/L (0.330 to 0.945 mmol/L, standard deviation 0.112 mmol/L). Only 4.5% of gouty arthritis patients and none of the tophaceous gout patients had SUA within the defined therapeutic targets at the time of recruitment. At study end, mean SUA was significantly reduced to 0.364 mmol/L (-0.165 mmol/L; 95% confidence interval -0.124 to -0.190; P<0.00001). The percentage of patients achieving pre-defined target SUA were 38.9% and 53.7% for patients with and without tophi respectively. During the study period, 25 episodes of adverse incidents were detected. Majority (68%) was related to skin rash and pruritus. Thirty-one patients (34.8%) were identified to have drug concordance problems including self-adjustment of dosage and self-stopping of drug treatment.
Conclusions Adverse drug effects and drug non-concordance were common in gouty arthritis patients receiving urate lowering therapy. A dedicated rheumatology nurse follow-up programme allows timely detection and intervention of treatment related problems to enhance the achievement of recommended target urate levels.
Disclosure of Interest : None declared
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