Taking the sting out of gout

Gout is a type of arthritis caused by excess uric acid in the blood. It is characterised by sudden attacks of intense pain that result in reduced quality of life, work absence and disability. The standard treatment for the condition involves close monitoring of blood urate levels and medication, but the high level of health professional support required to ensure a long term cure of gout is rarely delivered: fewer than half of eligible patients receive preventive treatment and fewer than half of those on treatment receive an adequate dose of medication.

The GoutSMART system has the potential to relieve the suffering of individuals with gout while also bringing healthcare savings by providing better care at reduced cost.

How it works

GoutSMART uses finger-prick urate meters combined with a smartphone app and linked web portal to facilitate direct management of an individual’s gout. The goal is to find the correct dose of medication to keep the blood urate level below a certain threshold and so prevent a flare-up, although the patient must continue to take medication throughout their life.

The GoutSMART app prompts the patient to carry out a finger-prick test and to submit the reading to the app, which uses this information to calculate a daily dose of medicine tailored to the patient’s individual need. Tests are initially conducted at least once a fortnight, becoming less frequent as the appropriate dosage is established, with each suggested dosage approved by a clinician. Although the clinician’s involvement is not strictly necessary, it was found that patients preferred this additional step.

The patient is notified of any change in their dosage. They then either accept the change or refuse it and send a message to the clinician. If the finger-prick result was good and no change is required, the patient receives an encouraging message from the app.

The technology

The app was written with React Native, a mobile app development framework that allowed us to write a single code base from which to generate iOS (iPhone) and Android apps.

The app communicates with a web portal that securely hosts patient data and the results of the readings on the secure EPCC web portal.

A proof of principle study is now underway and we are very excited to be in the process of recruiting patients.

The smartphone app and linked web portal were developed in collaboration with EPCC, working with our Lothian Gout Patient Advisory Group. It was generously funded by Edinburgh and Lothians Health Foundation.

Authors

Amy Krause, EPCC

Philip Riches

MRC Institute of Genetics and Molecular Medicine