Kanon Jatuworapruk, MD, PhD

Gout flares occurred in 18% of patients with comorbid gout who were hospitalized for COVID-19, adding up to 3 days to hospital length of stay (LOS), according to Kanon Jatuworapruk, MD, PhD.

In the past 2 years, Dr. Jatuworapruk explained, COVID-19 has been a key reason for hospitalizations, and gout has been linked with increased incidence of a COVID-19 diagnosis, as well as COVID-19-related morbidity. This is “most likely due to the high burden of comorbidities in [the] gout population,” he said. However, data on gout flares during COVID-19 has been limited to small case series. Therefore, information on gout flare prevalence during COVID-19 remains vague.

To address this knowledge gap, Dr. Jatuworapruk and colleagues sought to describe the incidence of, and outcomes in, patients with comorbid gout who were hospitalized for COVID-19, examining hospital LOS and factors linked with gout flare. Results of the retrospective study were published in The Journal of Rheumatology. The researchers included adults with comorbid gout admitted to three hospitals with COVID-19 between March 2020 and December 2021. The researchers assessed characteristics, prevalence, and outcomes of gout flare. LASSO selection and multivariate logistic regression were utilized to examine factors linked with gout flare. In contrast, multivariate linear regression was used to explore the link between gout flare and hospital LOS.

Patients With Suboptimal ULT Were at Greater Risk for Gout Flare

Of 8,697 patients hospitalized for COVID-19, 146 patients with comorbid gout were included; gout flare was identified in 18% of patients.

Patients with gout flare had higher baseline serum urate and less use of gout flare prophylaxis medications and urate-lowering therapy (ULT) compared with those without flare.

Two or more anti-inflammatory medications were used to treat one-third of patients with gout flare episodes. A GOUT-36 rule of 2 or greater, which is a predictive index for inpatient gout flare, was identified by logistic regression as the sole factor linked with gout flare (OR, 5.46, 95% CI, 1.18-25.37).

“Gout flare was found to be independently associated with hospital [LOS] and added [3] days to hospital course,” the study authors wrote, adding that those at high risk for gout flare during COVID-19 hospitalization appeared to be patients with suboptimal ULT. “These data suggest [that] people admitted with COVID-19 with a pre-existing diagnosis of gout and who are at high risk for developing gout flare (GOUT-36 rule ≥2) may need closer attention from the attending doctors to ensure that their existing ULT are [being] continued and that gout flare is detected and treated as early as possible.”