Objective. Self-monitored, point-of-care urate measuring devices are an underexplored strategy to improve adherence to urate-lowering therapy and clinical outcomes in gout. This study observed patient-led urate self-monitoring practice, and assessed its influence on; allopurinol adherence, urate control, and health-related quality-of-life.
Methods. People with gout (n=31) and prescribed allopurinol self-monitored their urate concentrations (HumaSens2.0plus) at baseline and thereafter monthly for 12 months (3 months per quarter). Adherence to allopurinol was measured using medication event monitoring technology (MEMS® cap). Time spent below target urate concentration (<0.36 mmol/L) was determined. Health-related quality-of-life was measured using a survey (EQ-5D-5L). Gout flares were recorded. Two-tailed Spearman correlation and Wilcoxon matched-pairs signed-rank test (p<0.05) were used for statistical comparisons.
Results. Most participants were male (94%) with urate concentrations below target (74%) at baseline. Overall, seven participants demonstrated repeated periods of “missed doses” (≤2 allopurinol doses missed consecutively) and “drug holidays” (≥3 missed). Most (94%) participants persisted with allopurinol. Time spent within target urate concentrations increased 1.3-fold (79% to 100%, p=0.346) and the incidence of gout flares decreased 1.6-fold (8 to 5, p=0.25) in the final compared to the first quarter of the study. Health-related quality-of-life was reduced for participants reporting at least one gout flare (median utility values 0.9309 versus 0.9563, p=0.04).
Conclusion. Patient-led urate self-monitoring may support the maintenance of allopurinol adherence, improve urate control, thus reducing the incidence of gout flares. Further research on patient-led urate self-monitoring in a randomised controlled study is warranted.