Urate Self-Monitoring Improves Medication Adherence in Gout

Stephen Hughes, PhD

Credit: ResearchGate

Patients with gout who participated in 12-months of monthly urate self-monitoring reported the approach led to better gout control coupled with a less restricted lifestyle, according to a study published in Health Expectations.¹ They believed self-monitoring was a useful and convenient way to management their condition independently.

Additionally, these patients learned how their behavior, such as diet and medication adherence, influenced their urate. In doing so, the cohort was more motivated to self-monitor regularly to ensure they stayed within the target urate concentration.

Urate-lowering therapy (ULT) is often prescribed to reduce urate below the target concentrations and reduce flare risk, which increases when serum urate concentrations exceed .36 mmol/L.²

“However, adherence to ULT is suboptimal, with nearly half of the people with gout discontinuing ULT within the first 6 months of initiating therapy,” wrote a team of investigators including Stephen Hughes, PhD, of the School of Pharmacy, Faculty of Medicine and Health at the University of Sydney, Australia. “Reasons for poor ULT adherence include how people with gout interact with doctors about their gout, their experiences with taking their gout medication and experiences and frequency of gout flares.”

Thirty Australian patients with gout were included in a 12-month observational feasibility trial of urate self-monitoring to better understand the experiences and acceptability of self-monitoring among this patient population. Patients were required to monitor their urate at least once a month using a point-of-care device. They were also educated on how to reduce risk of flare by maintaining target urate and received a graph of urate concentrations on a monthly basis.

Data including age, sex, residency, allopurinol dose, and disease duration were collected at enrollment. Urate data, which was monitored electronically, was sent to providers with the patient’s permission, which helped to determine clinical decisions, such as dose changes.

At the end of the 12-month period, patients participated in semi-structured interviews regarding their urate self-monitoring experience. Questions included past experiences of ULT, understanding of urate and ULT, the impact of having access to urate readings, and opinions on the practical aspects and implementation of self-monitoring in gout management. Responses were analyzed thematically.

Patients reported valuing the ability to self-monitor their urate and better understand urate control, as opposed to the annual monitoring required by their providers.

Participants said the process was easy, convenient, and informed their self-management behaviors including dietary modifications like exercise, hydration, and medication routines.

Interestingly, many patients used self-monitoring to assess changes in urate concentration in response to the feeling a flare was imminent or whether behaviors, such as alcohol intake, increased their risk of a gout flare.

Investigators noted limitations including enrolling long-term users of allopurinol, as their views may not be generalizable to patients initiating ULT. As patients had monthly conversations with interviewers, the familiarity may have influenced patients to respond more positively. Further, all patients had previous experience in self-monitoring their urate, so their views could skew more positively than an inexperienced patient. Investigators also mentioned subjects may have also been motivated to improve their gout management. Therefore, there may be other benefits for those who are less motivated that they were unable to identify. Despite these limitations, results were consistent with the opinions of patients with gout who had no experience in self-monitoring urate.

“Further research on implementing urate self-monitoring in routine care would enable an evaluation of its impact on medication adherence and clinical outcomes, as well as inform gout management guidelines,” investigators concluded.

References

1. ^{Michael TJF, Chan JS, Hughes S, et al. The experiences and perspectives of people with gout on urate self-monitoring. Health Expect. 2024;27(3):e14071. doi:10.1111/hex.14071}
2. ^{Uhlig T, Karoliussen LF, Sexton J, et al. One- and 2-year flare rates after treat-to-target and tight-control therapy of gout: results from the NOR-Gout study. Arthritis Res Ther. 2022; 24: 88. doi:10.1186/s13075-022-02772-3}