Optimising gout treatment: insights from a nurse-led cohort study.

OBJECTIVES: Currently, gout management, particularly urate-lowering therapy (ULT), is often suboptimal. Nurses successfully manage various diseases including gout. As gout prevalence is rising, and rheumatologists and general practitioners face shortages, a new approach is imperative. This real-life prospective cohort study evaluated the effectiveness of nurse-led care employing a treat-to-target strategy for gout management over a 2-year period. METHODS: All consecutively confirmed gout patients were included. The nurse-led clinic provided a structured treatment plan with consultations, patient leaflets, telephone contacts and laboratory monitoring. After a year of nurse-led care, patients transitioned to continued care in general practice. Follow-up data were complete through registries. The primary outcome was achieving target p-urate levels (<0.36 mmol/L) at 2 years after diagnosis. Secondary outcomes included treatment continuation and achievement of target p-urate levels in specific subgroups. The results were compared with patients diagnosed in the same clinic but followed up in 'usual care'. RESULTS: In the nurse-led group (n=114), 83% achieved target p-urate levels and ULT was continued by 98%. This trend persisted across various patient subgroups. Only 44% of patients in usual care achieved target p-urate and with insufficient doses of allopurinol . Nurse-led care involved an average of two visits and three telephone contacts over 336 days. The 2-year mortality rate was 15%. CONCLUSIONS: Nurse-led gout care, employing a targeted approach, was associated with a very high uptake of and adherence to ULT. The encouraging results were not achieved in usual care although a direct comparison might be influenced by selection bias.

Biological therapy and international travel: A questionnaire survey among Danish patients with rheumatic disease.

OBJECTIVE: To describe travel activities, preparations, and health problems encountered by patients with arthritis receiving biological therapy. METHODS: A travel survey was conducted in a Danish rheumatology outpatient clinic by distribution of a semistructured questionnaire to 300 consecutive patients with arthritis. RESULTS: Among the 273 (91%) patients returning the questionnaire, a history of traveling outside Denmark was reported by 203 (74%) respondents and outside Europe by 92 (34%). In 81% of the patients, travel activities had not decreased after the initiation of biological treatment. However, 24% reported that they had become more cautious regarding the choice of travel destination. Pre-travel advice was sought by less than one-third of the patients, whereas travel insurance was taken out by 86%, but only half of them had disclosed information about the biological treatment. Treatment was discontinued temporarily while traveling in 26% of patients on subcutaneous biologics. The main reason for discontinuation was concern about transport and storage of medicine. Only 6% of the travelers had experienced health problems, which were of only minor importance. CONCLUSION: Treatment with biologics seems not to have any major influence on international travel activity among Danish patients with arthritis. Health problems when traveling were of minor importance. However, pre-travel advice issues, including treatment compliance, transport of medicine, and insurance coverage, need to be addressed proactively by the outpatient clinic staff as part of patient consultation.