Background Gout is the most common chronic inflammatory arthritis worldwide and the only curable. Yet, gout care remains suboptimal despite evidence of the benefits of a treat-to-target approach to normalise urate levels. The efficacy and cost effectiveness of nurse led care in this treat-to-target strategy has been well recognised (Fuller, 2020)

Objectives:

• To implement a patient centred treat-to-target urate lowering strategy within a holistic health promotion, secondary prevention model of advanced practice nursing.

• To engage, raise awareness and educate patients about:

• i) the short and long-term health implications of hyperuricaemia and

• ii) the merits of self-management strategies to improve their health outcome

Methods With stakeholder agreement a gout clinic was established. The Making Every Contact Count (MECC) framework was used to implement the treat-to-target approach per the EULAR (European Alliance of Associations for Rheumatology) recommendations for the management of gout. Making every contact count, grounded in a behavioural change approach, promotes brief intervention therapy to support lifestyle behaviour change to make each routine contact with patients count in terms of chronic disease healtcare (Meade, 2022: Gwinnutt, 2023). The 12-question Gout Self-Management Knowledge Questionnaire was completed at baseline, followed by a nursing educational intervention through a planned gout programme and repeated at final visit (Fields, 2017).

Results To date 102 patients have attended the clinic. Baseline and final clinic assessments are available for 42 patients. The number of clinic reviews per patient was 6. Thirty-five (83%) were male; mean age was 61 years (range 29-91); mean disease duration was 9 years (range 1-40). The mean time to diagnosis from symptom onset was 4 years (range 0-29). At baseline, 17 (40%) reported a family history and past experience of a urate-lowering therapy. The reported mean number of flares per-annum was 1-2 (n=20); 3-5 (n=17); >6 (n=5); 20 patients (48%) had podagra; 14 patients (33%) had tophi. Urate levels improved by 76%, falling from a baseline of 397 µmol/L to 301 µmol/L at final visit; an 83% improvement was seen in the Gout Self-Management Knowledge Questionnaire. The subjective numeric global health score (0-10, where 10 represents worst health status) showed a median score of 1.5 at baseline and 1 at final visit.

Conclusion Findings demonstrated 1) normalisation of urate to target levels, 2) an improvement in patients’ insight and 3) a parallel upgrading in patients reported global health score.

References [1] Fuller, A., Jenkins, W., Doherty, M. and Abhishek, A., 2020. Nurse-led care is preferred over GP-led care of gout and improves gout outcomes: results of Nottingham Gout Treatment Trial follow-up study. Rheumatology, 59(3), pp.575-579.

[2] Meade, O., O’Brien, M., Mc Sharry, J., Lawless, A., Coughlan, S., Hart, J., Hayes, C., Keyworth, C., Lavoie, K.L., Murphy, A.W. and Murphy, P., 2022. Enhancing the implementation of the Making Every Contact Count brief behavioural intervention programme in Ireland: protocol for the Making MECC Work research programme. HRB Open Research, 5.

[3] Gwinnutt, J.M., Wieczorek, M., Balanescu, A., Bischoff-Ferrari, H.A., Boonen, A., Cavalli, G., De Souza, S., De Thurah, A., Dorner, T.E., Moe, R.H. and Putrik, P., 2023. 2021 EULAR recommendations regarding lifestyle behaviours and work participation to prevent progression of rheumatic and musculoskeletal diseases. Annals of the rheumatic diseases, 82(1), pp.48-56.

[4] Fields, T.R., Rifaat, A., Yee, A.M., Ashany, D., Kim, K., Tobin, M., Oliva, N., Fields, K., Richey, M., Kasturi, S. and Batterman, A., 2017, April. Pilot study of a multidisciplinary gout patient education and monitoring program. In Seminars in arthritis and rheumatism (Vol. 46, No. 5, pp. 601-608). WB Saunders.

Acknowledgements: NIL.

Disclosure of Interests Madeline O’Neill: None declared, Douglas Veale Shareholder of: Health Beacon, Speakers bureau: AbbVie, BMS, Celgene, Galapagos, Gilead, Janssen, MSD, Pfizer, UCB, Paid instructor for: Consultant/Advisor: AbbVie, Actelion, BMS, Galapagos, Gilead, Janssen, MSD, Pfizer, UCB, Regeneron/Sanofi, Novartis, Grant/research support from: AbbVie, Amgen, Boehringer Ingelheim, BMS, Eli Lilly, Novartis Janssen, Pfizer, UCB, MSD, Eamonn Molloy: None declared, Carl Orr Speakers bureau: AbbVie, Patricia Minnock: None declared.