{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T17:09:29Z","timestamp":1788196169320,"version":"build-2803163510"},"reference-count":29,"publisher":"BMJ","issue":"2","license":[{"start":{"date-parts":[[2024,4,23]],"date-time":"2024-04-23T00:00:00Z","timestamp":1713830400000},"content-version":"unspecified","delay-in-days":22,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["RMD Open"],"accepted":{"date-parts":[[2024,4,8]]},"published-print":{"date-parts":[[2024,4]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Currently, gout management, particularly urate-lowering therapy (ULT), is often suboptimal. Nurses successfully manage various diseases including gout. As gout prevalence is rising, and rheumatologists and general practitioners face shortages, a new approach is imperative. This real-life prospective cohort study evaluated the effectiveness of nurse-led care employing a treat-to-target strategy for gout management over a 2-year period.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>All consecutively confirmed gout patients were included. The nurse-led clinic provided a structured treatment plan with consultations, patient leaflets, telephone contacts and laboratory monitoring. After a year of nurse-led care, patients transitioned to continued care in general practice. Follow-up data were complete through registries. The primary outcome was achieving target p-urate levels (&lt;0.36\u2009mmol\/L) at 2 years after diagnosis. Secondary outcomes included treatment continuation and achievement of target p-urate levels in specific subgroups. The results were compared with patients diagnosed in the same clinic but followed up in \u2018usual care\u2019.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>In the nurse-led group (n=114), 83% achieved target p-urate levels and ULT was continued by 98%. This trend persisted across various patient subgroups. Only 44% of patients in usual care achieved target p-urate and with insufficient doses of allopurinol . Nurse-led care involved an average of two visits and three telephone contacts over 336 days. The 2-year mortality rate was 15%.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Nurse-led gout care, employing a targeted approach, was associated with a very high uptake of and adherence to ULT. The encouraging results were not achieved in usual care although a direct comparison might be influenced by selection bias.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/rmdopen-2024-004179","type":"journal-article","created":{"date-parts":[[2024,4,25]],"date-time":"2024-04-25T02:40:42Z","timestamp":1714012842000},"page":"e004179","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":14,"title":["Optimising gout treatment: insights from a nurse-led cohort study"],"prefix":"10.1136","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8543-8447","authenticated-orcid":false,"given":"Claus","family":"Rasmussen","sequence":"first","affiliation":[{"name":"Department of Rheumatology, North Denmark Regional Hospital, Hjorring, Denmark"},{"name":"Department of Clinical Medicine, Aalborg University, Aalborg, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-3794-0942","authenticated-orcid":false,"given":"Jesper Walther","family":"Larsen","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, North Denmark Regional Hospital, Hjorring, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-7170-2646","authenticated-orcid":false,"given":"Heidi M\u00e4chler","family":"Christensen","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, North Denmark Regional Hospital, Hjorring, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5468-4944","authenticated-orcid":false,"given":"Monica Bak","family":"Larsen","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, North Denmark Regional Hospital, Hjorring, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-0751-6041","authenticated-orcid":false,"given":"Anna Marie","family":"Thomsen","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, North Denmark Regional Hospital, Hjorring, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-7020-3351","authenticated-orcid":false,"given":"Tinna","family":"Leishmann","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, North Denmark Regional Hospital, Hjorring, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6956-9698","authenticated-orcid":false,"given":"Jette","family":"Kragh","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, North Denmark Regional Hospital, Hjorring, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9618-9922","authenticated-orcid":false,"given":"Gunnar Lauge","family":"Nielsen","sequence":"additional","affiliation":[{"name":"Clinical Medicine, Aalborg Universitet, Aalborg, Denmark"},{"name":"Department of Internal Medicine, Fars\u00f8 Outpatient Clinic, Aalborg University Hospital, Aalborg Universitetshospital, Aalborg, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2024,4,24]]},"reference":[{"key":"2025090312432321000_10.2.e004179.1","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2013-204463"},{"key":"2025090312432321000_10.2.e004179.2","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/key390"},{"key":"2025090312432321000_10.2.e004179.3","doi-asserted-by":"publisher","DOI":"10.1038\/s41584-020-0441-1"},{"key":"2025090312432321000_10.2.e004179.4","doi-asserted-by":"crossref","first-page":"S9","DOI":"10.3949\/ccjm.75.Suppl_5.S9","article-title":"Epidemiology of gout","volume":"75 Suppl 5","author":"Weaver","year":"2008","journal-title":"Cleve Clin J Med"},{"key":"2025090312432321000_10.2.e004179.5","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2012-202421"},{"key":"2025090312432321000_10.2.e004179.6","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.107.703389"},{"key":"2025090312432321000_10.2.e004179.7","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2014-206792"},{"key":"2025090312432321000_10.2.e004179.8","unstructured":"Danish Society of Rheumatology . National guideline for the management of gout [In Danish]. 2021. Available: https:\/\/danskreumatologi.dk\/nbv\/sygdomme\/artritis-urica\/"},{"key":"2025090312432321000_10.2.e004179.9","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2011-200801"},{"key":"2025090312432321000_10.2.e004179.10","doi-asserted-by":"crossref","first-page":"337","DOI":"10.1111\/imj.14445","article-title":"Management of patients with gout and achievement of target serum Urate levels at a tertiary rheumatology service in Australia","volume":"50","author":"Bavanendrakumar","year":"2020","journal-title":"Intern Med J"},{"key":"2025090312432321000_10.2.e004179.11","article-title":"Patients with severe gout treated in mixed settings","volume":"68","author":"Rasmussen","year":"2021","journal-title":"Dan Med J"},{"key":"2025090312432321000_10.2.e004179.12","doi-asserted-by":"publisher","DOI":"10.1592\/phco.28.4.437"},{"key":"2025090312432321000_10.2.e004179.13","doi-asserted-by":"crossref","DOI":"10.1186\/s13075-016-1211-y","article-title":"Factors associated with 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gout","volume":"328","author":"Cipolletta","year":"2022","journal-title":"JAMA"},{"key":"2025090312432321000_10.2.e004179.23","doi-asserted-by":"crossref","DOI":"10.1136\/rmdopen-2019-001015","article-title":"Failure to reach uric acid target of <0.36 mmol\/L in hyperuricaemia of gout is associated with elevated total and cardiovascular mortality","volume":"5","author":"P\u00e9rez","year":"2019","journal-title":"RMD Open"},{"key":"2025090312432321000_10.2.e004179.24","first-page":"529","article-title":"Long-term persistence and adherence on urate-lowering treatment can be maintained in primary care-5-year follow-up of a proof-of-concept study","volume":"56","author":"Abhishek","year":"2017","journal-title":"Rheumatology (Oxford)"},{"key":"2025090312432321000_10.2.e004179.25","doi-asserted-by":"publisher","DOI":"10.3899\/jrheum.170381"},{"key":"2025090312432321000_10.2.e004179.26","doi-asserted-by":"publisher","DOI":"10.3899\/jrheum.190257"},{"key":"2025090312432321000_10.2.e004179.27","doi-asserted-by":"crossref","first-page":"758","DOI":"10.1002\/acr.23012","article-title":"Trends in gout and rheumatoid arthritis hospitalizations in Canada from 2000 to 2011","volume":"69","author":"Rai","year":"2017","journal-title":"Arthritis Care Res (Hoboken)"},{"key":"2025090312432321000_10.2.e004179.28","doi-asserted-by":"crossref","first-page":"1136","DOI":"10.1111\/1756-185X.13855","article-title":"A nurse-led, rheumatologist-assisted telemedicine intervention for dose escalation of urate-lowering therapy in gout","volume":"23","author":"Phang","year":"2020","journal-title":"Int J Rheum 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