Nurse-Led Telehealth for Gout

• Nurse-Led Self-Management Support (Other): The intervention offers four distinct support options. Patients are free to choose the option that best suits their preferences and needs. I1: App-Based Monitoring - Patients receive an app that provides relevant health information, including short educational videos, images, and other resources. Every three months, the app sends a pop-up reminder. I2: Reminder by Letter - Patients receive a friendly reminder every three months via e-Boks or postal mail (for those without e-Boks access) encouraging continued treatment adherence. I3: SMS Reminder - Patients receive a text message every three months to remind them to continue their treatment. I4: Phone Call Check-In - A nurse contacts the patient by phone three times per year at scheduled intervals to provide support and ensure they remain on track with their treatment.
• GP-follow up (Other): Patients in the control group will be discharged from the hospital and continue with routine care provided by their general practitioner (GP). The GP will receive a discharge letter outlining the recommended treatment plan. In addition, patients will receive a letter containing key information about their condition, along with a recommendation to consult their GP annually for ongoing disease monitoring.

Primary outcomes

• Proportion of participants achieving target serum urate (s-urate) concentration [52 weeks]: The number and proportion of participants with a serum urate concentration equal to or less than 0.36 mmol/L or 0.30 mmol/L if tophi, at 52 weeks after randomization.
• Gout impact [52 weeks]: Changes in Gout Impact Scale (GIS). GIS is a patient-reported outcome measure assessing the impact of gout on health-related quality of life. The GIS includes domains such as gout concern overall, gout medication side effects, unmet treatment need, well-being during gout attack, and concern during gout attack. Each domain is scored on a 0-100 scale, with higher scores indicating greater impact (worse health status). Change from baseline to week 52 will be calculated, with negative change scores indicating improvement (i.e., reduced gout impact).

Secondary outcomes

• Quality of life one year after discharge from a rheumatology clinic indicated by EQ-5D-5L. [52 weeks]: The EQ-5D-5L is a standardized measure of health status developed by the EuroQol Group, covering five dimensions (mobility, self-care, usual activities, pain/discomfort, and anxiety/depression), each with five levels of severity. An index score will be calculated based on country-specific value sets, with scores typically ranging from <0 (worse than death) to 1 (perfect health). Change from baseline to week 52 will be assessed, with positive changes indicating improvement in health-related quality of life.
• Proportion of participants adherent to urate lowering drugs based on CQR-5 [52 weeks]: Adherence to urate lowering drugs will be assessed using the Compliance Questionnaire Rheumatology 5-item version (CQR-5). The CQR-5 is a patient-reported questionnaire specifically developed to measure adherence in patients with rheumatic diseases. Each item is scored on a 4-point Likert scale, and an overall adherence score is calculated. Participants will be classified as adherent if their CQR-5 score is above the predefined threshold for good adherence (e.g., ≥80% predicted probability of adherence based on validated cutoff.)

Other outcomes

• Need for acute healthcare visits [52 weeks]: The difference in need for acute visits at rheumatologists of rheumatology nurses at the rheumatology department.
• All contacts to the rheumatology department [52 weeks]: The total number of contacts (in-person visits, telephone consultations, video consultations, and written communications) between participants and the rheumatology department during the 52 weeks follow-up period. Contacts include both scheduled and unscheduled interactions related to the management of gout.
• Change in Gout-related Global Assessment (PGA) score [52 weeks]: The Patient Global Assessment (VAS PGA) will be used to assess the patient's overall assessment of their disease status. The VAS PGA is a self-reported measure, where the participant marks their perceived disease activity on a 100 mm horizontal line, with 0 mm indicating "no disease activity" and 100 mm indicating "worst possible disease activity." Change from baseline to 12 months will be assessed, with a lower score indicating a reduction in perceived disease severity.
• Change in Health Assessment Questionnaire Disability Index (HAQ-DI) score [52 weeks]: The Health Assessment Questionnaire Disability Index (HAQ-DI) will be used to assess functional disability in participants with gout. The HAQ-DI consists of 20 questions across 8 domains, including dressing, rising, eating, walking, hygiene, reach, grip, and usual activities. Each question is scored from 0 (no difficulty) to 3 (unable to perform), with a higher score indicating greater disability. Change in HAQ-DI score from baseline to 12 months will be assessed, with a reduction in score indicating improvement in functional status.
• Number of gout flares [40 and 52 weeks]: The total number of gout flares experienced by each participant during the 52 week follow-up period. A gout flare is defined as a self-reported episode of acute joint pain, swelling, and/or erythema consistent with gout.
• Change in gout related pain measured by Visual Analog Scale (VAS) [40 and 52 weeks]: Gout related pain will be assessed using a Visual Analog Scale (VAS), where participants rate their current level of pain on a 100 mm horizontal line ranging from 0 mm ("no pain") to 100 mm ("worst imaginable pain"). Change from baseline to 52 week will be calculated, with negative changes indicating a reduction in pain intensity

Sex: All, ages: 18 Years to any

Inclusion Criteria:

* ≥18 years old
* Fulfills ACR/EULAR 2015 Gout Classification Criteria
* Estimated Glomerular Filtration Rate (e-GFR) >30 ml/min
* Prescribed Allopurinol or Adenuric, and achieved two consecutive serum urate levels of two consecutive serum urate levels of ≤0.30 mmol/l for patients with tophi and ≤0.36 mmol/L for patients without tophi
* Have sufficient Danish reading and writing skills to understand information and complete questionnaires.

Exclusion Criteria:

• Cognitively impaired, unable to understand or provide informed consent.