Piroska Maurer, Regina Herren, Tobias Manigold
Affiliation(s):
Inselspital Bern
Objective: Gout is the among the most prevalent arthritides worldwide and is associated with high morbidity, cardiovascular risk, and substantial healthcare burden. Despite effective urate-lowering therapies (ULT), many patients remain undertreated, particularly those with severe or complex disease. Nurse-led gout management has improved outcomes in primary care, but data in multimorbid tertiary center populations are lacking. We aimed to evaluate the effectiveness of a supervised nurse-led gout clinic in achieving and maintaining serum urate (UA) targets in a tertiary hospital cohort.
Methods: In this observational study at University Hospital Bern (May 2023–Jan 2026), 69 patients with confirmed gout were enrolled. Patients were assigned to UA targets of <300 µmol/L (Group 1: severe gout) or <360 µmol/L (Group 2: non-severe gout). An advanced Practice Nurse (APN) provided education, a rheumatologist provided pharmacological management per 2020 ACR guidelines. UA levels, flare frequency, prophylaxis, and treatment adjustments were monitored, with follow-up at six and twelve months.
Results: Group 1 required higher allopurinol doses than Group 2 (p<0.01). UA targets were achieved in 82% of Group 1 regimens and 68% of Group 2. Flare rates and prophylaxis use were comparable. At six and twelve months, 62–67% of Group 1 and 83–88% of Group 2 maintained UA targets. Failures were often due to external treatment modifications. No major ULT-related adverse events were observed.
Conclusion: Supervised nurse-led gout management effectively achieves UA targets in this difficult-to-manage cohort. Maintaining UA targets may benefit from shorter follow-up intervals and enhanced education for patients and healthcare providers.