Background/Purpose: Gout outcomes and severity are worst in African Americans compared to Caucasians with gout. Racial Disparities in gout are well-described. Few or no data exist for African Americans with gout from observational studies or randomized controlled trials (RCTs). Our objective was to assess if a culturally appropriate gout storytelling intervention is superior to an attention control for improving gout outcomes.

Methods: In a 12-month, multicenter, randomized controlled trial (RCT), African American (AA) Veterans with gout were randomized to gout storytelling intervention vs. a stress reduction video (1:1 ratio). The primary outcome was urate-lowering therapy (ULT) adherence measured with the MEMSCap™, an electronic monitoring system to measure medication adherence. Secondary outcomes included gout flares, serum urate, gout-specific health-related quality of life (HRQOL), and medication satisfaction

Results: The 306 male AA Veterans with gout, who met the eligibility criteria were randomized to the gout storytelling intervention (n=152) or stress reduction video (n=152; control); 261/306 (85%) completed the 1-year study. The mean age was 64 years, body mass index (BMI) was 33 kg/m², and gout disease duration was 3 years. The ULT MPR by MEMSCap™ (primary outcome) was similar in the intervention vs. control groups at each time point: 3-months, 73% versus 70%; 6-months, 69% versus 69%; 9-months, 66% versus 67%; and 12 months, 61% versus 64% (p >0.05 each). The number of gout flares in the last month were similar in the treatment versus control groups except at 9-months: 3-months, 1.4 versus 1.4 (p=0.55); 6-months, 1.3 versus 1.6 (p=0.53); 9-months, 0.7 versus 1.3 (p=0.03); and 12-months, 0.7 versus 1.0 (p=0.20; Figure 1). Serum urate levels and patient satisfaction with treatment were similar in the two groups at 6- and 12-months with no significant differences. Gout-specific health-related quality of life scores on GAQ-GIS were also similar in the treatment versus control group except lower/better scores in two subscale scores in the treatment group: gout medication side effects at 3-months, 32.8 vs. 39.6 (p=0.02); and unmet gout treatment need at 3-months, 30.9 vs. 38.2 (p=0.003), and at 6-months, 29.5 vs. 34.5 (p=0.03; Figure 1), respectively.

Conclusion: A culturally appropriate gout storytelling intervention was not superior to attention control for improving gout outcomes in AA Veterans with gout. More studies are needed to determine the subset of minorities with gout that can benefit from behavioral interventions such as this. We also need to design more effective behavioral interventions for people with gout, especially those with worse outcomes, such as racial/ethnic minorities.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/a-behavioral-intervention-to-improve-gout-outcomes-in-african-americans-with-gout-a-12-month-multicenter-randomized-controlled-trial/