GOUT-36 Rule Predicts Risk for Flares in Patients With Comorbid Gout and COVID-19

The GOUT-36 rule was found to predict gout flares, which occurred in 18% of patients with comorbid gout hospitalized for COVID-19 infection and an increased hospital stay by 3 days, according to study findings published in The Journal of Rheumatology.

Researchers conducted a multicenter retrospective cohort study between March 2020 and December 2021 across 3 hospitals in Thailand. They analyzed the prevalence, outcomes, and risk factors of gout flares among patients with comorbid gout and polymerase chain reaction (PCR)-confirmed COVID-19 infection.

Of the 8697 patients hospitalized for COVID-19 infection, 146 had gout and 26 (18%) experienced gout flares during hospitalization. The majority of patients (91%) had at least 1 comorbidity, with the most common being diabetes (42%), obesity (28%), and myocardial infarction (18%).

One-thirds of patients with gout flares received treatment with 2 or more anti-inflammatory medications. The most frequently used medications to treat COVID-19 infection included favipiravir (87%) and systemic corticosteroids (72%).

Approximately 75% of the patients with gout developed COVID-19 pneumonia and 14% required invasive ventilation. Gout flares independently increased hospital lengths of stay by 3 days, changing the average length of stay from 10 to 13 days.

Compared with patients with gout without flares, those who developed flares with COVID-19 had higher baseline serum urate levels and decreased use of urate-lowering therapies (ULTs) and gout flare prophylaxis medications.

Using logistic regression, the researchers analyzed 4 exposure variables for the prediction of risk for gout flares, including no preadmission ULT, no preadmission gout flare prophylaxis, the need for invasive ventilation, and the GOUT-36 rule of at least 2 (a predictive index for inpatient gout flares).

The only factor that corresponded with gout flares was the GOUT-36 rule of at least 2 (odds ratio [OR], 5.46; 95% CI, 1.18-25.37; P =.030), which classified 89% patients in the gout flare group as high-risk compared with 40% in the nonflare group.

Study limitations included lack of generalizability to populations other than Thai and the potential underestimation and underdiagnosis of gout and gout flares using COVID-19 databases. In addition, study results may not have been representative of unhospitalized patients with gout and COVID-19.

However, the study authors concluded, “These data suggest people admitted with COVID-19 with a pre-existing diagnosis of gout…who are at high risk for developing gout flare…may need closer attention from the attending doctors to ensure that their existing ULT are continued and that gout flare is detected and treated as early as possible.”

Disclosures: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.