The research, led by academics at the University of Nottingham and published in The Lancet, have shown that they have patients fully informed and involved in their care decisions can be more successful in managing gout
And the study, which was funded by the charity Versus Arthritis, highlights the importance of individualized patient education and engagement to treat the condition.
Professor Michael Doherty, in the University's Division of Rheumatology, said: "The nurses delivered recommended the best practice that includes full patient information and engagement and to the treat-to-target strategy for urate-lowering treatment and continue to take it regularly This results in the gradual elimination of the urate crystals that cause gout and subsequent clinical improvements.
"Although nurses delivered this care, the principles of patient education, treat-to-target urate-lowering strategy, and regular follow-up and monitoring are applicable to any health professional who treats people with gout to start with, long-term this becomes very cost effective. "
Gout is the most common type of inflammatory arthritis, which affects around 2.5% of adults in the UK and which causes episodes ("attacks") of severe joint inflammation and pain. It is sparked by the persistently high level of uric acid (urate) in the body, causing sodium urate crystals to slowly but continuously form in and around the joints.
Attacks are usually treated with anti-inflammatories like ibuprofen but doctors prescribe drugs such as allopurinol or febuxostat over the long term for patients who are prone to frequent flare ups.
Gout is the only form of arthritis that can be cured effect through the use of urate-lowering therapies (ULT). The ULT dose needs to be adjusted against the blood urate level until a low target level is achieved, this then prevents new crystals from forming and slowly dissolves away from the crystals that are there.
Patients can make lifestyle changes Also If appropriate, How can they lose weight if overweight, Which can help to bring down urate levels and other health benefits were generally unavailable.
However, currently, only 40% of patients receive ULT, usually at a fixed dose rather than gradually increasing the dose until a target level of urate is reached in the blood.
And getting patients to stick to their medication is tricky. Currently, only 40% of gout patients ever receive ULT, usually at a fixed dose rather than gradually increasing the dose until a target level of urate is reached in the blood. And getting patients to stick to their medication is tricky.
The research nurses had received training about their management and management, which reflected current recommendations, and delivered an individualized package of care. This included a holistic assessment, a discussion of perceptions about the illness, full information about its causes, consequences and treatment options, and patient involvement in shared decision-making.
The study found that nurse-led care was associated with a much higher uptake of ULT, with patients being more likely to stick to their treatment. At two years, 96 per cent of the nurse-led group were on ULT, compared to 56 per cent in the usual care group. And 95% of patients had urate levels in the blood below the required target level, compared to just 30 per cent in the GP-led group.
In addition, it was estimated that 400-500mg of allopurinol per day was needed to achieve the right level of blood urate, which is more than the top dose of 300mg per day prescribed by most UK doctors.
The nurse-led care significantly reduced flare-up frequency, reduced tophi and improved quality of life and was more cost-effective, saving the NHS money after five years.
Stephen Simpson, Director of Research at Versus Arthritis, said: "In spite of national guidelines on how to manage effectively, we know that many patients fail to receive any clear explanation of the condition prevents recurring attacks. The most common inflammatory form of arthritis, affecting one in every 100 people, this is not good enough.
"Currently, constraints on GPs are not fully aware of the benefits that come with taking their treatments. The patient-centered approach led by nurses in this study offers a convincing alternative that will not only help to alleviate problems in the long term but will also improve that person's quality of life.
The Nottingham team worked in collaboration with academics in Health Economics and Decision Science at the University of Sheffield and received invaluable advice from the Nottingham Rheumatology Patient and Public Involvement group during the development of the study.
The Nottingham team now plan to examine the feasibility of training existing Practice nurses to see if this results in equally good results. NICE is currently planning to develop UK Guidelines for Management of Gout and it is hoped that the GPs and other health practitioners who manage people with gout will be incorporated into their guide.