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Point-of-Care Uric Acid Testing

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Studies confirm that medication adherence is poor in gout.12 The immediate feedback offered by POC hemoglobin A1c testing improves glycemic control.13 One can imagine that what POC testing did for diabetes, it could also do for gout.

  • Fewer skipped doses of ULT: “I had a gout patient the other day whose SU was 11.0, but at our prior visit it was 5.0,” says Dr. Baer. “He admitted that sometimes he skipped his daily dose of allopurinol due to stomach upset. I asked him to take half the dose in the morning and the other half in the afternoon to alleviate this side effect and to repeat the uric acid test after taking the allopurinol faithfully for three consecutive days. His repeat SU level was 5.0. Patients don’t realize that if they skip a dose, uric acid levels rise quickly. So POC testing could give them a sense of how important it is to take ULT daily.”
  • POC testing prior to pegloticase infusion: Reinfusions of pegloticase shouldn’t be administered to patients with high uric acid levels, and POC testing could provide quick results.14 This would only be useful to a small fraction of patients, but useful nonetheless.
  • Cost saving: Self-management of oral anticoagulation therapy via home INR monitoring has proven to be cost effective, so one might infer that uric acid POC testing could yield similar savings for gout.15 However, the true value to both patients and the healthcare system would be in better gout care. The economic burden of uncontrolled gout cannot be overstated.16 According to a 2016 systematic literature review, cost estimates for gout treatment in the U.S. range from $7.7 billion for gout-specific costs to greater than or equal to $20 billion for total costs.17

    • Conclusion

    POC testing uric acid testing exists. A five-minute phone call between two rheumatologists yielded a list of five compelling arguments to support its use, and there are likely more. What will it take to make uric acid POC testing as common for gout patients as glucose monitors are for people with diabetes?

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    Samantha C. Shapiro, MDSamantha C. Shapiro, MD, is the executive editor of Harrison’s Principles of Internal Medicine. As a clinician educator, she practices telerheumatology and writes for both medical and lay audiences.

     

    References

    1. Shapiro SC. Treating to target in gout: The trouble with serum urate. The Rheumatologist. 2022 Jul 21. https://www.the-rheumatologist.org/article/treating-to-target-in-gout-the-trouble-with-serum-urate.
    2. Shapiro SC. Refractory gout is a myth: Tips from an expert. The Rheumatologist. 2022 Jul 2. https://www.the-rheumatologist.org/article/refractory-gout-is-a-myth-tips-from-an-expert/.
    3. Qaseem A, Harris RP, Forciea MA, et al. Management of acute and recurrent gout: A clinical practice guideline from the American College of Physicians. Ann Intern Med. 2017 Jan 3;166(1):58–68.
    4. Armstrong JA. Urinalysis in Western culture: A brief history. Kidney Int. 2007 Mar;71(5):384–387.
    5. Poppick L. Let us now praise the invention of the microscope. Smithsonian Magazine. 2017 Mar 30. https://www.smithsonianmag.com/science-nature/what-we-owe-to-the-invention-microscope-180962725.
    6. Nuki G, Simkin PA. A concise history of gout and hyperuricemia and their treatment. Arthritis Res Ther. 2006;8(Suppl 1):S1.
    7. UA Sure. https://www.uasure.com/about-us.
    8. Fabre S, Clerson P, Launay JM, et al. Accuracy of the HumaSensplus point-of-care uric acid meter using capillary blood obtained by fingertip puncture. Arthritis Res Ther. 2018 May 2;20(1):78.
    9. Riches PL, Sing K, Berg K. Point-of-care uric acid testing is useful in routine clinical care of gout. Arthritis Res Ther. 2019 May 9;21(1):117
    10. ISO 15197:2013. In vitro diagnostic test systems—Requirements for blood glucose monitoring systems for self-testing in managing diabetes mellitus. International Organization for Standardization. 2013. https://www.iso.org/standard/54976.html.
    11. FitzGerald JD, Dalbeth N, Mikuls T, et al. 2020 American College of Rheumatology guideline for the management of gout. Arthritis Rheumatol. 2020 Jun;72(6):879–895.
    12. Reach G. Treatment adherence in patients with gout. Joint Bone Spine. 2011 Oct;78(5):456–459.
    13. Cagliero E, Levina EV, Nathan DM. Immediate feedback of HbA1c levels improves glycemic control in type 1 and insulin-treated type 2 diabetic patients. Diabetes Care. 1999 Nov;22(11):1785–1789.
    14. Becker MA, Baraf HSB, Yood RA, et al. Long-term safety of pegloticase in chronic gout refractory to conventional treatment. Ann Rheum Dis. 2013 Sep 1;72(9):1469–1474.
    15. Sawicki PT, for the Working Group for the Study of Patient Self-Management of Oral Anticoagulation. A structured teaching and self-management program for patients receiving oral anticoagulation: A randomized controlled trial. JAMA. 1999 Jan 13;281(2):145–150.
    16. Flores NM, Nuevo J, Klein AB, et al. The economic burden of uncontrolled gout: How controlling gout reduces cost. J Med Econ. 2019;22(1):1–6.
    17. Kabadi S, Myers J, Bly C, et al. Health economics of uncontrolled gout in the United States: A systematic literature review [abstract]. Arthritis Rheumatol. 2016;68(suppl 10). https://acrabstracts.org/abstract/health-economics-of-uncontrolled-gout-in-the-united-states-a-systematic-literature-review.

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