Gout SMART

Transforming care delivery in gout

Background

Gout affects 1 in 40 of the UK population and is increasing globally. Effective treatment is widely available, however most patients continue to suffer recurrent flares of intense pain and reduced quality of life. Nurse-led monitoring of urate levels and treatment escalation is effective, but resource pressures prevent this being adopted by the NHS. Finger prick meters allow patient to self-test their own urate levels, just as diabetes patients measure their own blood sugar. The University of Edinburgh and NHS Lothian are pioneering a supported self-monitoring approach that has been shown to transform outcomes for patients with gout.

What have we done?

 We have developed a smartphone app (GoutSMART) which prompts patients to record diaries of their urate levels and gout flares. These results are reviewed by the healthcare team who then advise patients directly when their medicine dose needs adjusted. We carried out a trial of supported gout self-management using the GoutSMART app in 60 patients from Edinburgh. We have shown that patients using the app are far more likely to get their urate levels under control (a target urate of 0.3mmol/l was achieved by 72.5% GoutSMART users compared to 15% of usual care participants by 24 weeks). It takes time for good control of urate levels to lead to flares stopping but we have seen the rate of gout flares fall over time with our approach and after three years most participants (96.7%) had no flares at all.

What do patients think?

The self-monitoring approach has been enthusiastically adopted by patients who report it is easy to use and helps them to feel more in control of their condition. Two of the participants in the trial have spoken to Dr Riches about their experience.

What will happen next?

We are looking to carry out larger trials of this approach to establish that this approach will be cost-effective for the NHS. Please let us know if you would be interested in taking part and help us to improve the care of gout.

Click here to check your eligibility to join the study (not currently recruiting participants)