Hospitalized Patients with Gout and COVID-19 at Higher Risk of Poor Outcomes

Patients with gout who were hospitalized with COVID-19 were more likely to require ventilatory support and had higher rates of death. This may be due in part due to known risk factors, such as age and comorbidities, according to a study published in Open Rheumatology.¹

“Gout is associated with male gender, advanced age, and several comorbidities, including cardiovascular disease, chronic kidney disease, and obesity,” investigators explained. “These demographic factors and comorbidities are also associated with death related to COVID-19 in the general population and in people with rheumatic diseases. People with gout may therefore be at a higher risk of severe COVID-19 outcomes.”

Data was extracted between March 12, 2020, and October 25, 2021, from the COVID-19 Global Rheumatology Alliance (C19-GRA) registry. Investigators focused on patients with gout who were hospitalized due to COVID-19 and collected additional information including demographics, comorbidities, outcomes (such as oxygenation or ventilation support and death), and medication exposures.

Of the 348 patients diagnosed with gout and COVID-19 in the registry, 163 patients were hospitalized and subsequently included in the study. Patients had a mean age of 63 years, most (85%) were male, and 46% had 2 or more comorbidities. The most common comorbidities were hypertension (56%), cardiovascular disease (28%), diabetes mellitus (26%), chronic kidney disease (25%), and obesity (23%). The majority (79%) of patients were in remission or reported low disease activity. Glucocorticoids were used pre-COVID-19 in 11% (n = 18) of patients and colchicine was used in 12% (n = 20) of the cohort.

Most (68%) of patients required supplemental oxygen or ventilatory support. Although COVID-19-related death was reported in 16% (n = 26) of the cohort, 73% of deaths occurred in patients with 2 or more comorbidities.

The study was strengthened by representing diverse populations and including physician-confirmed gout diagnosis. However, certain limitations may hinder generalizability and the C19-GRA registry may have inherent selection bias in favor of rheumatic diseases commonly treated with immunosuppressive agents, such as rheumatoid arthritis, lupus, and systemic sclerosis. Further, most patients with gout are managed in a primary care setting. Those who are cared for by a rheumatologist are more likely to have more severe disease and a higher frequency of comorbidity. Patients who did not flare during COVID-19 infection may have been overlooked by physicians, further adding to the possibility of selection bias. Gout-specific variables, such as tophus and serum urate levels, were not included in the registry. The small cohort size limited secondary statistical modeling. Lastly, COVID-19 immunization status was added later, so investigators were unable to evaluate its role in clinical outcomes.

“Despite being the most common inflammatory arthritis in the general population, gout remains relatively neglected in COVID-19 guidelines and recommendations,” investigators concluded. “Patients with gout have also reported difficulty with their disease management during the pandemic and both improvements and declines in quality of life. Future research should focus on exploring the possible connections between comorbid gout and COVID-19 diagnosis and outcomes. Such knowledge may help clinicians make the most informed decisions when managing people with gout during the ongoing COVID-19 pandemic.”

Reference:

Jatuworapruk K, Montgomery A, Gianfrancesco M, et al. Characteristics and Outcomes of People With Gout Hospitalized Due to COVID-19: Data From the COVID-19 Global Rheumatology Alliance Physician-Reported Registry [published online ahead of print, 2022 Aug 24]. ACR Open Rheumatol. 2022;10.1002/acr2.11495. doi:10.1002/acr2.11495