Background/Purpose:

The concept of a multidisciplinary gout clinic is relatively new in Singapore. Changi General Hospital launched such a clinic in 2014 to provide treat-to-target management of gout in a shared care model of rheumatologists and pharmacists.

This study aims to demonstrate the effectiveness of a multidisciplinary gout clinic on the optimization of urate lowering agents to achieve target serum uric acid (sUA) levels.

Methods:

We reviewed case notes and medication records of gout outpatients who were started on either Allopurinol or Febuxostat in the 24 months prior to (pre-group) and 33 months following (post-group) the launch of the multidisciplinary gout clinic. Patients with stage 5 chronic kidney disease or end-stage kidney disease as well as those who defaulted their appointments were excluded.

The primary efficacy end-point was mean time taken to attain goal sUA in patients who achieved target sUA between both pre- and post- groups. Secondary outcomes include percentage of patients who experienced a gout flare at one year of drug initiation, the mean dose of urate lowering therapy required to achieve target sUA levels, the proportion of patients that achieved target sUA of 360µmol/L or less at one year of drug initiation and mean reduction in sUA.

Results:

In 98 eligible subjects enrolled in our study, 50 patients were managed only by the rheumatologist (pre-group) and 48 patients were seen by both the rheumatologist and pharmacist (post-group). Among patients who have achieved target sUA level, the mean time taken to attain target sUA was shorter in the post-group as compared to the pre-group (147 days vs. 314 days, p<0.001). The percentage of patients who experienced a gout flare at one year of drug initiation is lower in those who achieved target sUA levels as compared to those who did not achieve target sUA levels (29.5% vs. 78.4%, p<0.001). The mean (standard deviation) daily allopurinol and febuxostat dose to achieve target sUA levels were 276mg (138mg) and 76mg (37mg) respectively. A higher proportion of patients achieved sUA of 360µmol/L or less at one year of drug initiation in the post-group as compared to pre-group (70.8% vs. 22.0%, p<0.001). The mean change in sUA among pre-group and post group were 113.02 µmol/L vs. 169.27 µmol/L, p=0.049, respectively.

Conclusion:

Our results demonstrate that the implementation of a multidisciplinary gout clinic provides a more timely achievement of target sUA level and the attainment of goal sUA is associated with reduced incidence of gout flares. This suggests that a structured multidisciplinary approach is effective in providing better disease management in gout patients.

« Back to 2017 ACR/ARHP Annual Meeting

ACR Meeting Abstracts - https://acrabstracts.org/abstract/effectiveness-of-a-multidisciplinary-gout-clinic-on-timely-achievement-of-serum-uric-acid-goals/