The development and effectiveness evaluation of gout treat-to­ target booklet intervention in improving gout outcome / Nasrul Mustafa

Background: The treat-to-target serum uric acid (SUA) approach is recommended in gout management according to the 2016 European League Against Rheumatism (EULAR) guidelines. Instruction for initiation and dose escalation for urate-lowering therapy may confuse the patient. Objectives: We aimed to develop and validate the Gout Treat-To-Target booklet and to assess its effectiveness as an intervention in improving gout outcomes compared to standard practice alone. Methods: This study was conducted in two phases; Phase I involved the development and validation of the Gout Treat-To-Target booklet and Phase JI was a single-centre interventional study on the effectiveness of validated Gout Treat­ To-Target booklet in improving gout outcome. Patient were seen at two-monthly interval. Result: 50 patients were recruited. The mean age of the patient was 46.5 years old. The mean gout duration was 11.2 years and tophi were found in 50% of patients. The patients were randomized via stratified block randomization into two groups; the intervention group (24 patients) and the control group (26 patients). with a. All patient received formal education of at least secondary school. 50% of patients had tophi. The baseline mean SUA was 559.8 (77.9) µmol/L in the intervention group and 605.4 (90.6) µmol/L in the control group. At 16 weeks, 20 patients (41.6%) achieve target SUA. We found three factors associated with the achievement of serum uric acid (SUA); use of the Gout Treat-To-Target booklet, lower baseline SUA and presence of tophi. Conclusion: The Gout Treat-To-Target booklet was validated for use in clinical practice. It is an effective tool to achieve the desired SUA level in 41 % of patients at 16 weeks, in addition to standard clinical practice.