UNCONTROLLED GOUT AS A POSSIBLE CAUSE OF COMORBIDITY AND A RISK FACTOR FOR A SEVERE COVID-19 COURSE
Summary. Despite the prevalence of comorbidity in gout patients, information about the management of gout in the context of coronavirus disease 2019 (COVID-19) was underrepresented in leading rheumatological scientific publications. Objectives. Our aim was to identify the factors of unfavorable course of gout, to compare the prevalence of comorbidity and its therapy in patients with controlled and uncontrolled gout as well as to analyze the relationship of the serum uric acid (SUA) level with the severity of COVID-19 course. Materials and methods. A total of 136 male patients with gout were classified according to SUA level as follows: controlled (SUA <360 μmol/l) and uncontrolled gout (SUA ≥360 μmol/l). We conducted a comparative analysis of the clinical course of gout, its management, prevalence, and treatment of comorbidities between the two groups. The group with uncontrolled gout was further divided into three subgroups according to SUA level: 360–479, 480–599, and ≥600 μmol/l to assess the impact of SUA on the severity of COVID-19. Results. Patients with uncontrolled gout (77.9%) had significantly more frequent acute flares in the preceding year (p<0.001), higher gout activity (p<0.001), more limited physical functioning (p<0.001) as well as extremely low rates of SUA measurement in the last year (p<0.001) and urate-lowering therapy usage (p<0.001) in comparison with the target SUA level group. Prevalence of dyslipidemia (p<0.001), obesity (p<0.001), diabetes mellitus (p=0.005), hypertension (p=0.03), gastrointestinal pathology (p=0.003), chronic kidney disease 3–4 stages (p=0.004), nephrolithiasis (p=0.02), and medication use for the treatment of comorbidities (4 (2–6) vs 1 (0–3), p<0.001) were higher in uncontrolled group. More elevated SUA level was found to be a reliable predictor of a more severe clinical course in COVID-19 among patient with gout (χ2=37.154; p<0.001). Conclusions. A higher prevalence of comorbidities increasing considerably the overall drug use was identified in the uncontrolled gout group. A more severe course of COVID-19 was associated with a higher level of SUA.
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