Op0235-HPR Comparing a Nurse-Led Treat-to-Target Urate-Lowering Strategy With Usual Care for Gout Patients: A Prospective Cohort Study

Background: Gout is a common inflammatory arthritis linked to reduced quality of life and increased mortality. Currently, gout management, particularly urate-lowering therapy (ULT), is often suboptimal, with less than 40% of patients receiving adequate treatment. As gout prevalence is rising, and rheumatologists and general practitioners face shortages, a new approach is imperative. Nurses successfully manage various diseases in primary care, and studies have shown promising results for patients with gout managed by nurses. Objectives: This real-life prospective cohort study aimed to evaluate the effectiveness of nurse-led care employing a treat-to-target strategy for gout management compared to "treatment as usual" over a two-year period. Methods: Patients in the nurse-led cohort received nurse-led care for one year before dedicated transitioning to care in general practice. The nurse-led clinic, manned by specialized nurses trained in gout care, implemented a structured treatment plan encompassing consultation, patient leaflets, telephone contacts, and laboratory monitoring. Patients in the usual care cohort were treated with usual care from point of diagnosis until follow-up at two years. Usual care encompassed care within general practice and other departments, such as orthopedic surgery, emergency wards, and internal medicine. 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. All consecutively gout patients confirmed by microscopy were included. Results: Enrolling 286 patients (114 nurse-led care, 172 usual care), both groups were comparable at baseline (Table 1). In the nurse-led group, 83% achieved target p-urate levels, compared to 44% in usual care (p<0.0001) two years after diagnosis. This trend persisted across various patient subgroups (Figure 1). ULT was continued in 98% of the nurse-led group and 73% of the control group, albeit with lower allopurinol doses in usual care (235 vs. 306 mg/day). Nurse-led care involved an average of 2 visits and 3 telephone contacts over 336 days. The 2-year mortality rate was 4% in the nurse-led care group and 23% in the usual care group. Conclusion: Nurse-led gout care, employing a targeted approach, outperformed standard care. This study underscores the significance of patient education, engagement, and collaboration with general practitioners in long-term care. It points to a promising avenue for improving gout management, which is vital given the increasing prevalence of this condition and its associated burdens. REFERENCES: NIL. Acknowledgements: NIL. Disclosure of Interests: None declared.