TY - JOUR

T1 - Patient-led urate self-monitoring to improve clinical outcomes in people with gout: a feasibility study

AU - Michael, Toni J.F.

AU - Wright, Daniel F B

AU - Chan, Jian Sheng

AU - Coleshill, Matthew J.

AU - Aslani, Parisa

AU - Hughes, Dyfrig

AU - Day, Richard O.

AU - Stocker, Sophie L

PY - 2024/2/21

Y1 - 2024/2/21

N2 - 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.

AB - 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.

M3 - Article

JO - ACR Open Rheumatology

JF - ACR Open Rheumatology

SN - 2578-5745

ER -