Gout is the most common cause of inflammatory arthritis and affects an estimated 20,000 people in Edinburgh alone.
A small study allowed patients to manage their own condition using finger prick self-testing at home to measure their urate level—the amount of uric acid in the blood and the single most important risk factor for developing and controlling gout.
They then used a smartphone app—called GoutSMART—to communicate their results to a healthcare team, who provided instant treatment advice. Experts say the approach offers substantially improved management of urate levels compared with usual care.
The supported self-management approach could also help reduce the burden on the NHS by cutting down emergency attendance and prolonged stays in hospital, researchers say.
Sudden attacks
Gout is characterized by sudden attacks of intense joint pain, which can lead to a reduced quality of life and even disability. The number of people affected by gout has risen in recent years in line with an aging population, and due to increases in the rates of contributory conditions such as obesity and cardiovascular disease.
Despite effective and cheap drug treatment being available to protect against attacks, at least half of gout patients never receive it. Of those who do receive the treatment, at least half are not given an effective dose. Researchers from the University of Edinburgh say this is because of a lack of healthcare professional capacity to supervise treatment, and a lack of understanding from patients of how treatments work.
Urate lowering
The study, published in The Lancet Rheumatology, tracked the outcomes of 60 patients who had been recommended for urate lowering therapy by their doctor.
Forty patients in the self-management group were given a urate self-testing meter and received direct treatment advice from specialists after uploading their results to the app. Twenty were given usual care in which their management plan was implemented by their GP.
A urate target of 0.30 mmol/L or less at 24 weeks was reached by 73% of patients in the self-management group, compared to just 15% in the usual care group.
Researchers say larger trials are now needed to evaluate the clinical and cost-effectiveness of this approach.
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