european crystal network workshop

    Does therapeutic education improve gout management: the experience of lariboisière university hospital paris-france.


    O. Al Tabaa ¹, E. Gazaix Fontaine ¹, J. Herrou ¹, F. Lioté 1, 2, T. Bardin 1, 2, P. Richette 1, 2, A. Frazier 1 And H-K. Ea 1, 2

    1 Rheumatology Department, Centre Viggo Petersen, Lariboisière Hospital, Ap-Hp, Paris, France ² University Paris Diderot, Paris, France


    Background: Gout is a frequent and curable arthritis affecting 0.9% of adults in France. Its management remains suboptimal and less than one third of patients have efficient urate-lowering treatment (ULT). However, when individualized information were given and patients engaged in their care a treat-to-target strategy permits to achieve serum urate level (SU) at target (SU < 360 µmol/L) in more than 95% of patients. Therapeutic education sessions (TES) may improve patient knowledges, gout flare and ULT management.

    Objective: to assess the percentage of patients achieving SU target at 1 year after a TES.

    Methods: TES was set up in the department since January 2014. Patients willing to participate to TES responded to a questionnaire and were interviewed with a nurse assessing their knowledges, believes and gout representations. Each TES included 5 to 8 patients and was conducted according to participants’ needs. We retrospectively included all patients who had attended one TES between 1st January 2014 and 31th December 2017 and who had at least one visit between 9 and 15 months later. TES patients were matched in 1:1 with no-TES patients regarding age, sex and referent practitioner. For all patients were collected: demographics, disease duration, SU, treatments and comorbidities (type 2 diabetes, chronic kidney disease, hypertension, and cardiovascular diseases).

    Results: Overall, 54 TES patients were included and matched with 54 non-TES patients. Patients’ characteristics (demographics, disease duration, SU, treatments and comorbidities) were similar at baseline except for the body mass index (BMI) and the follow-up. BMI was higher (31.0 ± 5.7 vs 28.4 ± 5.0 kg/m², p=0.03) and the final visit shorter (11 ± 3.6 vs 14.4 ± 4.8 months, p=0,001) in no-TES patients than in TES patients, respectively.
    At final visit, 36 TES patients (67%) and 34 no-TES patients (63%) reached the SU target (< 360 µmol/L) (p=0.84). Moreover, 22 (41%) TES patients and 18 (33%) no-TES patients had a final SU < 300 µmol/L (p=0.43). There were no differences between groups (TES vs no-TES patients respectively) for: final SU (342 µmol/L ± 94 vs 338 ± 71, p=0.84), ULT (89% vs 96%, p=0.16), ULT dosage and hyperuricemic therapy (15% vs 11%, p=0.77).

    Conclusion: The percentage of patients achieving SU target after one single TES was high compare to literature data. However, it was not different from usual care achieved in our department, a tertiary care center expert in gout management. The diffusion of our savoir-faire and the TES will improve gout management.

    References: 1. Rees F, Jenkins W, Doherty M. Patients with gout adhere to curative treatment if informed appropriately: proof-of-concept observational study. Ann Rheum Dis. 2013 Jun;72(6):826–30.   2. Doherty M, Jenkins W, Richardson H, Sarmanova A, Abhishek A, Ashton D, et al. Efficacy and cost-effectiveness of nurse-led care involving education and engagement of patients and a treat-to-target urate-lowering strategy versus usual care for gout: a randomised controlled trial. The Lancet. 2018;392(10156):1403–1412.