Nurse-led care improves outcomes for people with gout

What have we achieved?

Research funded by Versus Arthritis showed that a package of nurse-led care can improve treatment for gout, compared to standard care. The new approach resulted in 95% of people reaching the recommended levels of urate in their blood, and patients reporting fewer painful and disabling gout attacks, leading to improved quality of life.

“I got my life back within a year” said Malcolm Coy, who received the treatment. “People don’t need to suffer that level of pain.”

What is gout?

Gout, the most common type of inflammatory arthritis in the UK, is a painful condition caused by crystals that form in and around joints. Gout affects people whose bodies make too much of a waste product called urate, or people whose kidneys can’t get rid of enough urate. These crystals can rub against the joint’s lining, causing swelling and inflammation.

What problem where we trying to solve?

With the right treatment, gout is one of the few forms of arthritis which can be very effectively controlled, allowing people with this condition to live free from pain and disability. Urate-lowering therapies (ULTs), such as allopurinol, have great potential to reduce painful symptoms and improve the quality of life for people with gout. However, only about half of people with gout take ULTs, and those who do take them do not always understand the right way to take them.

In addition, misconceptions about gout and lack of education mean that people may not be getting the best care.

At Versus Arthritis, we want to make sure that people living with the pain of gout receive the best treatment possible, so we funded a study to assess whether delivering care through specially trained nurses could help people with gout.

What research did we fund, and what did it reveal?

We funded a study, led by Professor Michael Doherty at the University of Nottingham, which trained nurses to deliver individualised care to people with gout. These nurses then delivered tailored education packages in the clinic and involved patients closely in making decisions about their treatment.

After two years, the provision of nurse-led care resulted in:

  • 9 out of 10 people having fewer gout attacks
  • Self-reported improvements in quality of life
  • 96% of patients taking ULTs (compared to 50% receiving standard care)
  • 95% of patients having recommended urate levels (compared to 30% receiving standard care).

Nurse-led care was also shown to save the NHS money over the longer term, by keeping people’s gout under control.

How did this study change the way health professionals treat gout?

Since Professor Doherty and his team shared these findings, the National Institute for Health and Care Excellence, or NICE, has created guidelines on how to treat gout which recommend that everyone with gout is offered ULTs to help prevent attacks.

Malcolm’s story

One person whose life was transformed by nurse-led gout care was Malcolm, who enrolled in the study that we funded. Malcolm is no stranger to pain. Having served in the Marines, Malcolm has endured being “…shot, stabbed and blown up, and the pain of that was nothing compared to gout.” And when a gout attack happens to Malcolm, “…it takes over completely; I can’t function, can’t move, nothing relieves it.”

Despite the fact that his gout attacks were becoming more frequent, Malcolm’s GP did not adjust the dose of allopurinol that Malcolm took.

By the time Malcolm had been living with increasing pain, anxiety and depression for four years, he said, he was in a ‘dark place’ and had considered suicide.

But when Malcolm enrolled in the study and began working with his nurse, Wendy, “I got my life back within a year”, he said. His allopurinol dose increased, his urate levels dropped, and his pain subsided. Today, Malcolm describes himself as gout-free. “I’m passionate about getting the message out there that gout is easily treatable,” said Malcolm.

Malcolm's story

What’s next?

This research has highlighted that if best practise guidelines are adhered to, including monitoring of gout patients and individualised care, treatment is very effective for gout. Versus Arthritis has been working with leading health care education provider Red Whale to deliver webinars, including a session to address the treatment of gout in primary care and encourage best practise.

Professor Michael Doherty said: “We’re now looking to use our best practice model in GP practices to show that it is feasible and cost effective. We want to train practice nurses and even look at linking gout checks with yearly cardiovascular assessments. This approach would help us to check urate levels regularly and treat the condition as soon as signs of gout start to appear, which would help lots of people.”

We are also currently funding a research project to help design a full-scale clinical trial looking at whether omega-3 fatty acids, which are found in fish oils, can be used alongside ULTs to prevent gout attacks. The results could reduce gout attacks and overcome the unwanted side effects that some people experience when starting on ULTs.