Performance of a Supervised Nurse-led Outpatient Clinic for Difficult-to-manage Gout Patients at a Tertiary Center

BackgroundGout 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. ObjectiveTo evaluate the effectiveness of a supervised nurse-led gout clinic in achieving and maintaining serum urate (UA) targets in a tertiary hospital cohort. MethodsIn 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 {micro}mol/L (Group 1: severe gout) or <360 {micro}mol/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. ResultsGroup 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. ConclusionSupervised 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.