Background Currently there is no guideline in treating gout in the Nederlands. The Outpatient Department of Rheumatologyof the University Hospital St. Radboudhasmade guidelines based on the Eular/British guidelinesand followed by a health care professional. The targets are-Attack free without profylaxis at 6 months; -serum uric acid concentration ≤ 0.30 mmol/l.
Objectives The purpose of this study is to gain insight in conventional gout care by different rheumatologists versus care by onehealth care professional.
Methods Usinganobservational study, 2patient cohorts arecompared during a follow-up of one year. A retrospective medical files study was performed for the control group (n=30) whom received conventional specialist care. Starting the gout clinic at November 2011 (n 53) consecutive patients are included in the intervention group.
Results Demographic data are similar in both groups. Medical file analysis of the control group showed limited documentation about frequency and duration of the gout attacks or patient compliance. There are less frequent and also shorter gout attacks at t=12 (weeks) and t=52 in the intervention group. Allopurinol has been prescribed more frequently and higher-dosed within the intervention group at t=12. Colchicine use was lower in the intervention group. Dosing and administration methods of steroids were not uniform. In both groups NSAIDs are rarely prescribed.
Conclusions Despite thelimitations of this study (small patient numbers, short follow-up period and suboptimal documentation in the control group), there is a clear trend to more intensive monitoring and care in the intervention group. This can be done by a specialist nurse under supervision from a rheumatologist versus gout care as usual. This also suggests that treating to a predefined target according to guidelines may well lead to improved treatment results in gout patients. A decrease in disease burden (a lower frequency and shorter duration of gout attacks) and lower serum urate were achieved. This study invites further research with a larger number of gout patients and extendedfollow-up, preferably within a multi-centre prospective cohort of gout patients. This could lead to a Dutch guideline allowing a more uniform and effective treatment of gout to be achieved.
References EULAR evidence based recommendations for gout (2006). Part I. - EULAR evidence based recommendations for gout (2006). Part II.- BSR British Society for Rheumatology and British Health Professionals in Rheumatology Guideline for the Management of Gout (2007).
Disclosure of Interest None Declared
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