IMPACT of COVID-19 on the CLINICAL COURSE of GOUT and the OVERALL USAGE of MEDICATION in PATIENTS with GOUT

Background: Data on the course and outcomes of the coronavirus disease 2019 (COVID-19) in patients with gout are scarce, as gout is underrepresented in leading COVID-19 and rheumatological Scientific publications [1]. Objectives: To describe clinical changes, quality of life, therapy of gout before and after COVID-19, and the clinical course of severe acute respiratory syndrome-related coronavirus 2 (SARS-Cov-2) infection in the cohort of patients with gout. Methods: In total, 84 males with gout were examined before the pandemic, during COVID-19 (March 2020 to December 2021) and 6 months after SARS-Cov-2 infection. The severity of COVID-19 in our cohort was determined. We conducted a comparative analysis of clinical and laboratory data, Gout Activity Score (GAS), urate-lowering (UST) and symptomatic therapy, Physical Component Summary (PCS) and Mental Component Summary (MCS) of the Short Form 36 (SF-36) Health Survey Questionnaire. Statistical difference of qualitative indicators was carried out using the Pearson Chi-square test (χ2), quantitative indicators using the Student's or the Wilcoxon test between groups. Results: The mean age (mean±SD) of the study patients was 51.07±7.45 years and the disease duration was 9.84±6.02 years. Most SARS-CoV-2 infected patients with gout exhibited a moderate illness (40.48%), almost every third (28.57%) had mild, 21.43% had severe and 9.52% had critical illness. Comparison of pre-COVID-19 vs 6-month post-COVID-19 data demonstrated an increase of gout fares in preceding 6 months (0.7±0.59 vs 4.35±2.25, p<0.001), serum uric acid level (5.9±1.54 vs 7.62±1.99, p<0.01), GAS (3.83±0.4 vs 6.1±1.63, p<0.01), non-steroidal anti-infammatory drug intake (19.05% vs 72.62%, p<0.001), colchicine (27.38% vs 53.6%, p<0.001), and corticosteroid use (5.95% vs 34.52%, p<0.001), but decreased intake of ULT (88.09% vs 77.38%, p>0.05), SF-36 PCS (43.7 ± 6.19 vs 36.08±6.54, p<0.01) and SF-36 MCS (48.35±5.89 vs 40.13±6.84, p<0.01). Conclusion: The current study identifed the majority of patients with gout had a moderate course, every ffth had a severe course and 9.52% had a critical course of COVID-19. In the post-COVID-19 period, we found a six-fold increase in gout fares, rising gout activity by 59.3%, more frequent medication use for symptomatic therapy of gout, decreased physical and mental health in the cohort of patients with gout.

Comorbidity and its impact on the course of gout and COVID-19

Introduction. Comorbid diseases significantly exacerbate gout burden, represent an even more elevated risk of hospitalization and mortality rates owing to the coronavirus disease 2019 (COVID-19) than gout itself. Objectives. To evaluate the influence of the modified Rheumatic Disease Comorbidity Index (mRDCI) on the clinical course of gout and COVID-19. Methods. Using data from 136 male participants with gout, we distributed the cohort according to values of the mRDCI as follows: 0 - without comorbidities, 1-2 - low comorbidity index (CI), 3-4 - moderate CI and ≥5 - high CI. “Treat-to-target” approach for gout, the association of mRDCI with the clinical course of gout, lipid metabolism, and severity of COVID-19 were analyzed. Results. According to mRDCI scores, almost every second gout patient (45.6%) had moderate CI, every fifth (19.1%) - high CI, and 14.7% - low CI. Greater mRDCI was associated with the higher severity of COVID-19 (p=0.003), limited physical functioning (r=0.5, p<0.001), higher body mass index (r=0.63, p<0.001), hyperuricemia (r=0.37, p<0.001), increased low-density lipoprotein cholesterol (LDL-C) (r=0.38, p<0.001), higher gout activity (r=0.4, p<0.001), more frequent acute flares in the preceding year (r=0.39, p<0.001), number of tophi (r=0.31, p<0.001), longer duration of gout (r=0.34, p<0.001), reduced glomerular filtration rate (r =-0.39, p<0.001), and daily excretion of uric acid (UA) (r=-0.28, p=0.001). The target level of serum UA was achieved in 22.1%. The majority of patients were not controlled for LDL-C (83.7%), blood pressure (75.5%), and glucose (69.44%) in the cohort with dyslipidemia, hypertension, and diabetes respectively. Conclusion. The high prevalence of comorbidities in gout patients was associated with the severity of COVID-19. We have established the following three patterns of comorbidity predictors: anthropometric, disease-related, and dysmetabolic. The management of gout requires a multidisciplinary approach. © Svitlana Smiyan, Olha Makhovska, 2022