AB0111 PERFORMANCE OF A NURSE-LED OUTPATIENT CLINIC IN A REAL WORLD GOUT COHORT AT THE LARGEST TERTIARY CENTER IN SWITZERLAND
Authors: T. Manigold, R. Herren
Journal: Annals of the Rheumatic Diseases (2024)

<h3>Background:</h3> Gout is the most common inflammatory arthritis in Western countries and is sharply increasing in developing countries. Gouty arthritis leads to immobilization, hospitalizations, treatments and work absences, putting a significant on the healthcare systems. Despite the existence of effective urate-acid (UA) lowering drugs, adherence to drugs as well as capacities of management by general and specialized practitioners appear to be suboptimal. However, nurse-led outpatient clinics in the UK have been shown to result in effective treatment to UA-target levels &lt; 360umol/l and higher adherence rates by patients when compared to general practitioner (GP)-management [1,2]. <h3>Objectives:</h3> Here, we report on the first results eight months after implementation of a nurse-led gout outpatient clinic at the largest university hospital in Switzerland and including patients with complex comorbidities, such as organ transplantation. <h3>Methods:</h3> A total of 28 confirmed gout patients were assessed and treated in the outpatient clinic during 66 visits at the largest tertiary center in Switzerland. Follow-up visits were usually scheduled every 2-4 weeks. All patients received a brief assessment by a rheumatologist, In addition, general information regarding non-pharmacological therapy such as dietary and lifestyle adjustments was provided by a specialized nursing professional. Most of the patients had received little to no comparable information prior to this initial consultation. Modification of urate-acid lowering therapy, addition of anti-inflammatory or other drugs were prescribed by the rheumatologist upon each visit. Patients were studied prospectively with regards to their UA, Cholesterol, HbA1c, blood pressure and BMI values. <h3>Results:</h3> 23/28 patients were already on UA-lowering therapy before their first visit. While seven patients were already at their UA-target at their first visit, twenty-one patients were beyond UA target and needed treatment escalation. Among them, 10/21 had a UA target of &lt;360umol/ and 11/21 had a UA target of &lt;300umol/l. UA target levels were reached 6/19 (31.6%) at visit two, an additional 4/11 (36.4%) at visit 3 and 1/5 (20%) at visit 4, respectively. Mean UA levels were reduced from 486.2umol (visit 1) to 398.3umol/l (visit 3). Importantly, in 3/5 patients not reaching UA target at visit 3, oxypurinol levels were undetectable at visit 4, suggesting lack of adherence to treatment. In addition, months after reaching UA-target levels two patients experienced a relapse of UA levels and arthritis episodes, due to inconsistent drug adherence. Assessment of other life and metabolic parameters is pending due to the short observation interval. <h3>Conclusion:</h3> In line with previous studies in patients with GP profile, our data in tertiary center patients suggests that UA target levels can be achieved within two visits (approximately eight weeks) and within a nurse-led outpatient setting. Loss of adherence was seen in approximately 10% of patients. This is noteworthy, as in patients of a University hospital there is likely a higher bias for complex comorbidities and adverse events to drugs. Moreover, half of the patients had severe gout with UA-target of &lt;300umol/l. However, after the induction phase additional follow-up visits may be helpful to ensure therapy adherence and screening for drug tolerability. Expansion and additional follow-up visits of our cohort are necessary to confirm these results and assess effect of UA-lowering therapy on additional life and metabolic parameters. <h3>REFERENCES:</h3> [1] Efficacy and cost-effectiveness of nurse-led care involving education and engagement of patients and a treat-to-target urate-lowering strategy versus usual care for gout: a randomised controlled trial. Doherty M, et al. Lancet. 2018 Oct 20;392(10156):1403-1412. [2] Nurse-led care is preferred over GP-led care of gout and improves gout outcomes: results of Nottingham Gout Treatment Trial follow-up study. Fuller A, et al. Rheumatology (Oxford). 2020 Mar 1;59(3):575-579. <h3>Acknowledgements:</h3> <b>NIL.</b> <h3>Disclosure of Interests:</h3> Tobias Manigold Hoffmann LaRoche, Janssen, Novartis, Hoffmann LaRoche, Novartis, Hoffmann LaRoche, Hoffmann-LaRoche, Novartis, Janssen, EliLilly, Hoffmann LaRoche, Sandoz, Regina Herren: None declared.