Affecting about 4 percent of all adults in the United States, according to the Arthritis Foundation, gout is a form of arthritis that presents as painful, swollen, stiff joints, especially in the big toe. It is caused by a buildup in the blood of uric acid, a normal waste product of the breakdown of certain foods. Too much uric acid causes the formation of painful crystals in the joints. Difficult to diagnose, gout can painfully flare for 3 to 10 days, then remain asymptomatic for months or years afterward. RELATED: 10 Hot and Cold Therapy Tips to Tame Joint Pain
Medications and Lifestyle Changes Are Used to Treat Gout
Treatment usually involves anti-inflammatory and uric-acid-lowering medications, along with lifestyle changes such as:
Limiting alcohol, sugary drinks, and saturated fatsMaintaining a healthy body weightVitamin C supplementsAvoiding food triggers like red meat, organ meat, high fructose corn syrup, and some seafood (anchovies, sardines, herring, mackerel, scallops)Eating more fruits, vegetables, and whole grains
A Team Effort Is Key to Managing Gout, Results Suggest
A new study published online February 13, 2018, in Arthritis Care & Research, however, shows that treat-to-target (T2T) protocols vastly improve management of gout. Treat-to-target is a paradigm in which physicians and patients work together to outline treatment goals regarding pain level, function, and disease activity, which are then measured at every checkup. If target levels are not met, the physician will make appropriate adjustments. “Treat-to-target represents a high standard of care because it allows physicians and patients to work collaboratively to set goals about treatment based on both numbers (lab results, blood work, disease activity measures) and patients’ experience and reporting of disease activity symptoms, like pain and functionality,” says W. Benjamin Nowell, PhD, the director of patient-centered research at CreakyJoints.
Comparing Treat-to-Target Results to Typical Treatment Results
Researchers at Geisinger Medical Center in Danville, Pennsylvania, piloted the study on primary care gout management improvement intervention. At one primary care site, gout patients were given treat-to-target care; at a second site, the gout patients were not. Under treat-to-target, gout patients were given access to:
Engagement of intervention site staffSurveys of provider performance improvement preferencesOn-site live and enduring online educationElectronic Health Record reminders
In addition, providers at the intervention site received monthly reports comparing their outcomes with those of the non-intervention site. Both sites had three quality measures assessed monthly: Percent of
Gout patients treated with therapy to lower uric acidTreated patients monitored with serum uric acidTreated patients at target uric acid.
After Six Months, the T2T Group Showed Big Improvement
The results were very clear: At six months, the treat-to-target group had significantly improved on all three quality measures. Patients who received the intervention were 3.5 times more likely to be monitored and two times more likely to achieve their uric acid goal than those at the control site.
People With Gout Need to Educate Themselves on Disease Care
Dr. Nowell says, “This study of gout patients provides good evidence that people with arthritis have better outcomes when treatment protocols are implemented against management metrics. Gout patients sometimes believe they will be able to manage their symptoms with dietary changes alone. It’s important for adherence and long-term outcomes that arthritis patients, including those with gout, understand the rationale for their treatment plan and are able to see the improvement for themselves.”
Doctors Must Also Change Their Care Behavior
“The thrust of our study highlights that changing healthcare provider behavior to improve healthcare delivery is challenging. While treating to a target uric acid number was one of the measures for which there is evidence that it improves gout treatment, it was the intervention at multiple levels in the workflow of a primary care provider that ultimately led to improvement in achieving this goal. Education about what is the best treatment is not enough. Showing providers evidence that treating to a target uric acid level improves care is not nearly enough. To improve healthcare delivery, there in addition must be provider active engagement in the workflow process redesign to effectively improve care,” says Alfred Denio, MD, of the Geisinger Medical Center rheumatology department, one of the study’s authors.
