The impact of the COVID-19 pandemic, both direct and indirect, are going to be felt for years to come. Thankfully, there are effective vaccination therapies to protect individuals from COVID-19; however, cases in both vaccinated and unvaccinated people continue to occur each day. Being able to identify individuals who are more susceptible to breakthrough infections may benefit other strategies in mitigating risks and controlling outbreaks.
Gout is a common form of inflammatory arthritis. Individuals with gout often suffer from multiple comorbidities, including obesity, cardiovascular disease (CVD), and chronic kidney disease (CKD), which have been associated with higher risks of COVID-19 infection and worse outcomes. In addition, hyperuricemia, elevated serum urate levels in the blood and the cause of gout, contributes to inflammatory states that may complicate or exacerbate COVID-19 symptoms.
Arthritis & Rheumatology published a population-based study investigating the association between gout and the risk of COVID-19 infection and its severe sequelae, particularly after prior COVID-19 vaccination. The authors of the study conducted two cohort studies utilizing the IQVIA Medical Research Database to quantify the risk of COVID-19 infection, hospitalization, and death among individuals with gout and compared them with individuals without gout.
The primary outcome was a confirmed diagnosis of COVID-19, and secondary outcomes included risk of hospitalization for COVID-19 infection and death within 30 days of a COVID-19 infection. The gout cohort comprised 54,576 vaccinated and 61,111 unvaccinated individuals, and there were 1,336,377 vaccinated and 1,697,168 unvaccinated individuals in the non-gout cohort. The gout cohort was more likely to be male, have comorbidities, more frequently use medications, and visit their primary care doctors more often than the individuals in the non-gout cohort.
“Compared with the general population, the risk of breakthrough infection among individuals with gout was significantly higher than among the general population,” the authors wrote. In gout individuals who were vaccinated, 1955 cases of breakthrough infections occurred, and 52,468 cases occurred in vaccinated individuals without gout. The authors estimated the rate difference and hazard ratio of breakthrough infections for individuals with gout to be 0.91 and 1.24, respectively.
In total, 184 hospitalizations occurred in the vaccinated gout cohort compared with 1956 in the vaccinated non-gout cohort. Twenty-eight individuals died in the vaccinated gout cohort, and there were 141 deaths in the vaccinated non-gout cohort; however, there were no statistically significant differences in death between the gout and non-gout unvaccinated cohorts. Women with gout had a higher risk of death compared with the non-gout cohorts, but there was no association observed in men with gout.
The authors conceded that “The biological mechanisms linking gout to the risk of SARS-CoV-2 infection remain unclear and deserve further investigation.” They advised individuals with gout, even after vaccination and women in particular, should consider additional preventative measures to mitigate the risk of COVID-19 and breakthrough infections.