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Improving gout care

Example of impact type:

The HRC funded Professor Lisa Stamp at the University of Otago to lead the first-ever randomised controlled trial demonstrating an improved dosing strategy using allopurinol to help more patients to manage their gout symptoms. Gout is the most common form of inflammatory arthritis and is more prevalent in New Zealand than any other country. Over 160,000 patients in New Zealand suffer from gout, the majority of whom are Māori or Pacific people.

The key management goal of long-term treatment is the reduction of blood uric acid levels to <0.36mmol/l. If this treatment target is maintained, gout attacks will cease. Allopurinol is the most common urate-lowering therapy both in New Zealand and worldwide; however there is no one size fits all dosage. For many people with gout, doses have historically been restricted based on kidney function. Yet, this restriction results in many people failing to achieve the treatment target. Increasing the dosage has not been a suitable solution because of an associated increased risk of adverse effects.

Professor Stamp’s research showed that gradual dose increases of allopurinol over time was safe, could prevent on-going attacks of the painful disease, dramatically improved patients’ lives, and could also help stop the disease from progressing to a chronic state in many patients. The dosing strategy has been translated into clinical practice at both primary and secondary care level and is now reflected in national and international gout management guidelines (the American College of Rheumatology (ACR) Gout Guidelines and the European League Against Rheumatism Gout Guidelines).

Professor Stamp continues to update Canterbury Health Pathways, an initiative for facilitating translation of findings into clinical care, with results from her HRC-funded research on managing gout in the community. Professor Stamp, supported by a research partnership with Kaikōura Medical Centre, successfully piloted the delivery of a package of care incorporating education, gout treatment and appropriate screening and management of important co-morbidities associated with gout such as heart disease and diabetes, in a rural general practice environment. Her research was undertaken with considerable community participation and engagement including Te Tai o Marokura (Māori Health Providers), Māori health promoters, the local Marae and local pharmacies.

Given the breakthrough research of both the clinical treatment and community management of gout, for which she received the Medicines NZ 2017 Value of Medicines Award, Professor Stamp and her colleague Professor Tony Merriman are now focused on prevention.

Supported by the HRC, their innovative research has already identified gene variants that explain some of why Māori and Pacific people have the highest rates of gout worldwide, fuelling their exploration for how existing medications could specifically target the gene the team has identified.