Academic Rheumatology, University of Nottingham, City Hospital, Nottingham, UK.
Ann Rheum Dis. 2013 Jun;72(6):826-30. doi: 10.1136/annrheumdis-2012-201676. Epub 2012 Jun 7.
Many doctors believe that patients with gout are unwilling to receive urate-lowering therapy (ULT) and blame them for poor adherence to management.
To test the effectiveness of a complex intervention for gout that incorporates key elements of current guidelines, including full patient information, delivered in an optimal setting (specialist hospital clinic).
Observational study of patients reporting ongoing attacks of gout recruited from primary care lists. 106 participants (94 men, 12 women; mean age 61 years) were enrolled in the study. Patients received a predominantly nurse-delivered intervention that included education, individualised lifestyle advice and appropriate ULT. The predefined goal was to achieve serum uric acid (SUA) levels≤360 μmol/l after 1 year in at least 70% of participants.
Of the 106 participants at baseline, 16% had tophi; mean (SD) baseline SUA was 456 (98) µmol/l. All participants agreed to joint aspiration to confirm gout and all wished to receive ULT. At 12 months, 92% of the 106 participants had achieved the therapeutic target (SUA≤360 µmol); 85% had SUA<300 µmol/l. Allopurinol was the most commonly used ULT, requiring a median dose of 400 mg daily to achieve the target. Improvements in Short Form-36 were observed (significant for pain) after 1 year.
A predominantly nurse-led intervention including education, lifestyle advice and ULT can successfully achieve the recommended treatment target in more than 9 out of 10 patients. Full explanation and discussion about the nature of gout and its treatment options and individualisation of management probably account for this success.
许多医生认为痛风患者不愿意接受降尿酸治疗（ULT），并将其归咎于对治疗的依从性差。
测试一种包含当前指南关键要素的痛风综合干预措施的有效性，包括提供完整的患者信息，并在最佳环境（专科医院诊所）下进行。
对从初级保健名单中招募的持续发作痛风的患者进行观察性研究。共有 106 名参与者（94 名男性，12 名女性；平均年龄 61 岁）参与了该研究。患者接受了主要由护士提供的干预措施，包括教育、个性化的生活方式建议和适当的 ULT。预定的目标是在至少 70%的参与者中，在 1 年内将血清尿酸（SUA）水平降至≤360μmol/l。
在基线时的 106 名参与者中，有 16%有痛风石；平均（SD）基线 SUA 为 456（98）μmol/l。所有参与者均同意进行关节抽吸以确认痛风，并均希望接受 ULT。在 12 个月时，106 名参与者中有 92%达到了治疗目标（SUA≤360μmol）；85%的患者 SUA<300μmol/l。最常用的 ULT 是别嘌呤醇，需要每天中位数 400mg 的剂量才能达到目标。在 1 年后，SF-36 评分得到改善（疼痛方面显著）。
包括教育、生活方式建议和 ULT 的主要由护士主导的干预措施可以成功地使超过 9/10 的患者达到推荐的治疗目标。对痛风的性质及其治疗选择以及个体化管理的充分解释和讨论可能是成功的原因。
