URIKA - New app can give patients more control over gout

Many people live with gout for years without receiving treatment that addresses the underlying cause of the disease. Instead, they only receive pain relief and anti-inflammatory medication when they have an attack. Lack of uric acid-lowering treatment can lead to unnecessary suffering and an increased risk of permanent joint damage.

“The underlying cause is often not followed up well enough. This means that many people have far more pain and attacks than necessary,” says rheumatologist Johan Stjärne.

He is involved in research on a new app for people with gout at Diakonhjemmet Hospital. The study is called ReMonit Gout, and the app has been named Urika.

Seeking patients for study

The hospital is now looking for patients who are about to start uric acid-lowering medication to test the app in a larger study. If you experience an attack of gout, your doctor can contact Diakonhjemmet Hospital for a diagnosis of gout before you start treatment. You will then be considered for the study.

A common but underestimated disease

Gout is one of the most common inflammatory rheumatic diseases in men over 50 years of age. The risk increases with age. Up to one in ten men over 75 years of age have the disease. Women can also be affected, especially after menopause.

If you are genetically predisposed, a traditional Christmas menu can trigger seizures.

The attacks often come on suddenly, often at night. Many people wake up with a big toe that is so painful, red and swollen that it is difficult to move. Even light touch can be unbearable.

Previously, the disease was often called podagra (gout in the big toe), but today the term gout is used because other joints can also be affected.

What happens in the body during a seizure?

All people have uric acid in their blood. Uric acid is formed by the breakdown of purines, which either originate from the body's own cells when they break down, or from what we eat and drink.

Normally, there is a balance between the formation and excretion of uric acid, which occurs via the kidneys and intestines. If the concentration of uric acid becomes too high because too much is formed or too little is excreted, the uric acid can go from dissolved to solid form, crystallize and be deposited in joints.      

The immune system can perceive these crystals as foreign bodies. White blood cells attack them, resulting in a strong inflammatory reaction with swelling, heat, redness and intense pain. An attack usually lasts one to two weeks before it subsides.

The next attack may occur in the same joint or a different one, and it may take anywhere from weeks to several years between each attack. It is precisely this unpredictable course that makes many people underestimate the need for preventive treatment.

Not just lifestyle

Gout is often associated with factors such as obesity and high alcohol consumption. However, it is not true that gout is solely caused by lifestyle, Stjärne emphasizes.

– Heredity plays an important role, and other diseases, such as impaired kidney function, can also contribute. So it's not just about lifestyle.

However, diet and alcohol can affect uric acid levels.

– Alcohol should be used with caution – for many reasons. In the case of gout, when the kidneys are given the choice of whether to remove alcohol or uric acid, they choose alcohol first. The uric acid is thus left in the body.

Foods high in purines, including organ meats, red meat, certain types of seafood, and beer, can increase uric acid. At the same time, what triggers attacks varies from person to person.

What happens without preventive treatment?

Some patients only receive repeated seizure treatments. Others start with preventive medications that lower uric acid, but stop when seizures become less frequent.

– Then uric acid rises quickly again, and the risk of new attacks increases, says Stjärne.

Without treatment, attacks are likely to become more frequent, last longer, and affect more joints over time. Increasing amounts of crystals can accumulate in more and more joints, leading to joint damage. In addition to the big toe, other toes, ankles, knees, and fingers can also be affected. Crystals can also be deposited in tendons and under the skin.

– The longer you delay treatment, the longer it may take to remove the deposits and achieve a good result, he warns.

Knowledge and self-mastery

To control the disease, uric acid levels must be kept below the threshold for uric acid to change from liquid to solid. This is the goal of treatment. It requires consistent monitoring and gradual escalation of the medication dose.

“Many people take medication but don't know their own uric acid levels. Then they don't know whether the treatment is actually working well enough,” says Stjärne.

The Urika app can give the patient a better overview of their uric acid level and treatment goals.

The Urika app

Urika is a digital app for people with gout. It is designed to give patients a better overview of their disease and treatment.

The app provides users with short films and texts about gout and its treatment. They can set reminders for when to take their medication and receive notifications about their next blood test.

The blood samples are used to measure uric acid levels. Initially, the samples are taken monthly. When the patient enters the results into the app, it calculates the recommended dose for the following month, in line with the treatment plan.

Once the desired uric acid level is reached, blood tests become less frequent.

Good results from the first study

The app has already been tested in a small study with 21 participants. The patients found the app to work well and were satisfied with the treatment.

Diakonhjemmet Hospital is now recruiting patients with newly diagnosed gout to investigate the Urika app in a larger study. The participants will be followed for two years. Half will be randomly selected to use the Urika app, while the other half will be randomly selected to receive regular follow-up from a nurse, without the app.

After two years, the results will be evaluated. If the findings are as positive as in the first study, approval for wider use of the app will be sought. The project group is also developing an app for patients with gout, who receive follow-up from their GP.

– The goal is to give patients better tools to manage their own illness. When you become more involved in the treatment, it is also easier to take greater ownership, says Johan Stjärne.

He hopes the research can help change how gout is monitored.

– This is a disease that is often treated in a stepmotherly manner. It is important to highlight that there is good treatment and that many people can completely avoid seizures with proper follow-up.

----

Facts: The ReMonit Gout Study

What: Clinical study investigating whether digital follow-up with the coping app Urika provides as good treatment for gout as traditional follow-up.

Who: People over 18 years of age with newly diagnosed gout who are starting uric acid-lowering treatment.

How: Participants are followed for two years. Half receive follow-up via the Urika app, half receive regular follow-up. The app provides information about the disease and treatment, reminders about medications and blood tests, and support for dose adjustment based on uric acid levels.

Goal: Better disease control, increased self-management and fewer attacks.

Where: Diakonhjemmet Hospital, Clinic for Rheumatology, outpatient clinic and research.

Recruitment: Patients with recent onset gout may be considered for participation. The GP or hospital physician can contact Diakonhjemmet Hospital directly to have the patient assessed for inclusion in the study.