Educated Nurses are Better than Primary Care Doctors at Managing Gout

In our centre, the management of gout by primary care physicians is rather poor. Many patients are on suboptimal doses of Allopurinol, Febuxostat is not used appropriately in renally impaired patients, uric acid levels are usually above target, and patients suffer from continued attacks of gout. This often results in significant work disability. It really is surprising because gout is quite simple to manage especially when caught early.

A study presented at EULAR compared trained nurse-led care to general practitioner (GP) care of 517 patients with gout in a prospective 2-year randomized controlled trial.

The results were as expected. More patients were adherent to therapy in the nurse-led group with fewer dropouts. Ninety-five percent of patients achieved a uric acid <360 umol/L in the nurse-led group versus 29% in the GP group. Ninety seven percent of patients were taking urate lowering therapy in the nurse-led group versus 54% in the GP group. The nurse-led group had significantly fewer attacks of gout compared with the GP-treated group (p<0.001) and fewer patients had tophi (2.6% vs 9.6%, respectively).

It is clear that educated nurse-led care of people with gout in this study was far superior to routine care provided by general practitioners.

The only issue with this study is the general practitioner group was not properly educated regarding current guidelines. That said, the educated nurses did a great job, with target uric acid levels achieved in >90% of patients, as well as improvements in patient-reported outcomes and quality of life. Furthermore, this may be a more cost-effective approach to treating gout in the community.

More reports from EULAR 2017