Gout and the COVID-19 pandemic.

PURPOSE OF REVIEW: This review gives an overview of recently published articles on COVID-19 and gout. RECENT FINDINGS: People with gout are likely to be at an increased risk of poor outcomes after COVID-19 infection due to comorbid cardiometabolic conditions. The effects of chronic hyperuricemia on trained immunity, and the hyperinflammatory state induced by gout itself may also play a role. Frequent courses of glucocorticoids for gout flares may be associated with adverse outcomes after COVID-19 infection and reduced immunogenicity to the COVID-19 vaccination. Similarities between the pathophysiology of gout flares and the dysregulated inflammatory response of severe COVID-19 have been identified. Medications used in the treatment of gout, including colchicine and interleukin-1 inhibitors, have shown promise in the treatment of COVID-19 in clinical trials. Overall, the COVID-19 pandemic has had a negative impact on gout care, with patients reporting more difficulty with disease control, accessing medications and healthcare, and poorer quality of life. SUMMARY: The COVID-19 pandemic has created many challenges for people with gout. At present, there is a lack of guidance on the management of gout during the pandemic and paucity of research assessing outcomes of COVID-19 infection in people with gout.

Gout and Excess Risk of Severe SARS-CoV-2 Infection Among Vaccinated Individuals: A General Population Study.

OBJECTIVE: Gout patients often have multiple comorbidities, making them susceptible to SARS-CoV-2 infection and poor outcomes. This study was undertaken to examine the association between gout and the risk of SARS-CoV-2 infection and severe outcomes, especially in patients who have received a SARS-CoV-2 vaccine. METHODS: We conducted 2 cohort studies using The Health Improvement Network in the UK. Individuals with gout and those without gout from the general population were followed up from December 8, 2020 to October 31, 2021. We estimated the rate difference (RD) and hazard ratio (HR) of SARS-CoV-2 infection and severe outcomes (i.e., hospitalization and death within 30 days after SARS-CoV-2 infection) for individuals with gout versus those without gout using a Cox proportional hazards model according to SARS-CoV-2 vaccination status. We adjusted for potential confounders by using overlap weighting of exposure scores. RESULTS: Among the vaccinated cohort, 1,955 cases of breakthrough COVID-19 infection occurred in 54,576 individuals with gout (4.68 cases per 1,000 person-months), and 52,468 cases occurred in 1,336,377 individuals without gout (3.76 cases per 1,000 person-months). The partially adjusted RD of breakthrough infection was 0.91 cases per 1,000 person-months (95% confidence interval [95% CI] 0.62-1.20 cases per 1,000 person-months), and the partially adjusted HR was 1.24 (95% CI 1.19-1.30). Gout was also associated with an increased risk of hospitalization (adjusted HR 1.30 [95% CI 1.10-1.53]) and death (adjusted HR 1.36 [95% CI 0.87-2.13]). Women with gout had an increased risk of hospitalization (adjusted HR 1.55 [95% CI 1.15-2.10]) and death (adjusted HR 2.46 [95% CI 1.12-5.41]). Similar associations with gout were observed in the unvaccinated cohort. CONCLUSION: These general population data suggest that individuals with gout, especially women, have higher risks of SARS-CoV-2 infection and severe outcomes, even when vaccinated.

Risk of gout flares after COVID-19 vaccination: A case-crossover study.

OBJECTIVE: Routine vaccinations are associated with an increased risk of gout flares. We examined the association between COVID-19 vaccination, an immunization program implemented to a large proportion of population, and the risk of gout flares. METHODS: We conducted a time-stratified case-crossover study among patients with gout who experienced gout flares between December 2020 and September 2021, using data from The Health Improvement Network. We compared the risk of gout flares on each of the seven days on and after the day of COVID-19 vaccination vs. no vaccination during that period using conditional logistic regression. In addition, we performed subgroup analyses stratified by different COVID-19 vaccines (i.e., BNT162b2, hereafter referred to as BNT, and ChAdOx1 nCov-19, hereafter referred to as ChAd). RESULTS: Among 5,904 patients with gout (mean age: 63·1 years; 85·5% male) who experienced gout flares within one month, the risk of gout flares slightly increased on the second day after COVID-19 vaccination (odds ratio: 1·44; 95% CI: 1·02 to 2·07). The risk of gout flares also slightly increased after receiving COVID-19 vaccine on other remaining days (ORs ranged from 1·03 to 1·22); however, none of them was statistically significant. An increased risk of gout flares on the second day after vaccination was mainly observed for the ChAd vaccine (odds ratio: 1·44; 95% CI: 1·00 to 2·05), but not for BNT vaccine (odds ratio: 1·18; 95% CI: 0·67 to 2·02). CONCLUSION: COVID-19 vaccination, mainly ChAd vaccination, slightly increases the risk of gout flares on the second day after vaccination. This finding reassures the safety of COVID-19 vaccination for patients with gout.

Colchicine prophylaxis is associated with fewer gout flares after COVID-19 vaccination.

OBJECTIVES: COVID-19 vaccination often triggers a constellation of transitory inflammatory symptoms. Gout is associated with several comorbidities linked to poor outcomes in COVID-19, and gout flares can be triggered by some vaccinations. We analysed the risk of gout flares in the first 3 months after COVID-19 vaccination with inactivated virus, and whether colchicine can prevent gout flares following post-COVID-19 vaccination. METHODS: A clinical delivery population-based cross-sectional study was conducted in the Gout Clinic at the Affiliated Hospital of Qingdao University between February and October 2021. Study participants were selected using a systematic random sampling technique among follow-up patients with gout. We collected data, including vaccinations and potential risk factors, using a combination of interviews, health QR codes and medical records. Logistic regression was used to adjust for covariates. RESULTS: We enrolled 549 gout participants (median age 39 years, 84.2% vaccinated). For the 462 patients who received COVID-19 vaccine, 203 (43.9%) developed at least one gout flare in the 3 months after vaccination. Most of these flares were experienced within 1 month after the first (99/119 (83.2%)) or second (70/115 (60.9%)) dose of vaccine. Compared with unvaccinated participants, COVID-19 vaccination was associated with higher odds of gout flare within 3 months (adjusted OR 6.02; 95% CI 3.00 to 12.08). Colchicine use was associated with 47% less likelihood of postvaccine gout flare. CONCLUSION: COVID-19 vaccination was associated with increased odds of gout flare, which developed mainly in month 1 after each vaccine dose, and was negatively associated with colchicine prophylaxis.

Gout and the risk of COVID-19 diagnosis and death in the UK Biobank: a population-based study.

BACKGROUND: There is a paucity of data on outcomes for people with gout and COVID-19. We aimed to assess whether gout is a risk factor for diagnosis of COVID-19 and COVID-19-related death, and to test for sex- and drug-specific differences in risk. METHODS: We used data from the UK Biobank, which included 15 871 people with gout. We used multivariable-adjusted logistic regression in the following analyses using a case-control study design: to test for an association between gout and COVID-19 diagnosis in the entire UK Biobank cohort (n=459 837); to test for an association between gout and COVID-19-related death in people who were known to have died or survived with COVID-19 (n=15 772); to test for an association between gout and COVID-19-related death in the entire UK Biobank cohort (n=459 837); and to assess risk of COVID-19-related death in a subset of patients from the UK Biobank cohort with prescription data, stratified by prescription of urate-lowering therapy and colchicine (n=341 398). Models 1 and 2 were adjusted for age group, sex, ethnicity, Townsend deprivation index, BMI, and smoking status. Model 2 was also adjusted for diagnosis of 16 other diseases that are established comorbidities of gout or established risk factors for COVID-19-related death. FINDINGS: Gout was associated with diagnosis of COVID-19 (odds ratio [OR] 1·20, 95% CI 1·11-1·29) but not with risk of COVID-19-related death in the cohort of patients diagnosed with COVID-19 (1·20, 0·96-1·51). In the entire cohort, gout was associated with COVID-19-related death (1·29, 1·06-1·56); women with gout had an increased risk of COVID-19-related death (1·98, 1·34-2·94), whereas men with gout did not (1·16, 0·93-1·45). We found no significant differences in the risk of COVID-19-related death according to prescription of urate-lowering therapy or colchicine. When patients with gout were stratified by vaccination status, the risk of diagnosis with COVID-19 was significant in the non-vaccinated group (1·21, 1·11-1·30) but not the vaccinated group (1·09, 0·65-1·85). INTERPRETATION: Gout is a risk factor for COVID-19-related death in the UK Biobank cohort, with an increased risk in women with gout, which was driven by risk factors independent of the metabolic comorbidities of gout. FUNDING: Health Research Council of New Zealand.

Some Remarks on the Coronavirus Pandemic in Europe Gout, Rheumatoid Arthritis, and the Risk of Death Related to Coronavirus Disease 2019: An Analysis of the UK Biobank

Summary Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was initially reported in China in late 2019 and rapidly spread across the world. On March 11, 2020, the World Health Organization (WHO) characterized the situation as a global pandemic. In response to the pandemic, the primary objectives of European countries were: to limit the spread of the virus, to protect the most vulnerable and health workers and to provide a clear quantification of the virus's process. This chapter focuses on the first phase of the pandemic. Diagnosis of a COVID-19 case includes a number of criteria such as epidemiological characteristics, the underlying symptomatology of the probable patient and laboratory confirmation. Coronaviruses present a distinctive genetic characteristic among all other viruses, which is also related to their variability. The particular characteristics of the SARS-CoV genome sequence have raised many questions as to its taxonomic classification. Objectives The objectives for this study were to assess whether gout and/or rheumatoid arthritis (RA) are risk factors for coronavirus disease 2019 (COVID-19) diagnosis and to assess whether gout and/or RA are risk factors for death from COVID-19. Methods We used data from the UK Biobank. Multivariable-adjusted logistic regression was employed in the following analyses: analysis A, to test for association between gout and/or RA and COVID-19 diagnosis (n = 473,139);analysis B, to test for association between gout and/or RA and death from COVID-19 in a case-control cohort of people who died of or survived COVID-19 (n = 2059);analysis C, to test for association between gout and/or RA and death from COVID-19 in the entire UK Biobank cohort (n = 473,139). Results RA, but not gout, was associated with COVID-19 diagnosis in analysis A. Neither RA nor gout was associated with risk of death in the group diagnosed with COVID-19 in analysis B. However, RA was associated with risk of death related to COVID-19 by using the UK Biobank cohort in analysis C, independent of comorbidities and other measured risk factors (odds ratio [OR] 1.9;95% confidence interval CI 1.2?3.0). Gout was not associated with death related to COVID-19 in the same UK Biobank analysis (OR 1.2;95% CI 0.8?1.7). Conclusion RA is a risk factor for death from COVID-19 by using the UK Biobank cohort. These findings require replication in larger data sets that also allow for inclusion of a wider range of factors.

Gout, Rheumatoid Arthritis, and the Risk of Death Related to Coronavirus Disease 2019: An Analysis of the UK Biobank.

OBJECTIVES: The objectives for this study were to assess whether gout and/or rheumatoid arthritis (RA) are risk factors for coronavirus disease 2019 (COVID-19) diagnosis and to assess whether gout and/or RA are risk factors for death from COVID-19. METHODS: We used data from the UK Biobank. Multivariable-adjusted logistic regression was employed in the following analyses: analysis A, to test for association between gout and/or RA and COVID-19 diagnosis (n = 473,139); analysis B, to test for association between gout and/or RA and death from COVID-19 in a case-control cohort of people who died of or survived COVID-19 (n = 2059); analysis C, to test for association between gout and/or RA and death from COVID-19 in the entire UK Biobank cohort (n = 473,139). RESULTS: RA, but not gout, was associated with COVID-19 diagnosis in analysis A. Neither RA nor gout was associated with risk of death in the group diagnosed with COVID-19 in analysis B. However, RA was associated with risk of death related to COVID-19 by using the UK Biobank cohort in analysis C, independent of comorbidities and other measured risk factors (odds ratio [OR] 1.9; 95% confidence interval CI 1.2-3.0). Gout was not associated with death related to COVID-19 in the same UK Biobank analysis (OR 1.2; 95% CI 0.8-1.7). CONCLUSION: RA is a risk factor for death from COVID-19 by using the UK Biobank cohort. These findings require replication in larger data sets that also allow for inclusion of a wider range of factors.