Colchicine touted for prevention of gout flare-ups after COVID-19 vaccination

Gout patients have about sixfold greater odds of experiencing a flare in the first few months after COVID-19 vaccination, but colchicine appears to keep these gout attacks at bay, as shown in a study from China.

In a cohort of 549 gout patients (median age 39 years, 84.2 percent vaccinated), 203 out of the 462 (43.9 percent) who received a COVID-19 vaccine had at least one gout flare in the 3 months after vaccination. Multivariable logistic regression analysis confirmed that immunization upped the likelihood of a flare within those months (adjusted odds ratio [OR], 6.02, 95 percent confidence interval [CI], 3.00–12.08). [Ann Rheum Dis 2022;doi:10.1136/annrheumdis-2022-222199]

On the contrary, prophylactic use of colchicine (0.5 g once or twice daily ≥1 month at any time during the vaccination period) nearly halved the risk of having an increased gout flare burden after vaccination (adjusted OR, 0.53, 95 percent CI, 0.31–0.92).

“The findings of this clinical delivery population-based cross-sectional study provide important implications for COVID-19 vaccine administration in people with gout,” according to the investigators.

“COVID-19 vaccination often triggers a constellation of transitory inflammatory symptoms,” including gout flares, they added.

In the present study, most patients developed a flare within 1 month after the first (99 out of 119, 83.19 percent) or second (70 out of 115, 60.87 percent) vaccine dose. The flares were mild to moderate, although the mean visual analogue score was higher in the second-dose vaccinated patient group than the first-dose vaccinated group (5.65 vs 5.02; p=0.04). Gout flares occurred frequently in first metatarsophalangeal, ankle, or heel (after the first dose: 85.7 percent; after the second dose: 94.8 percent).

Notably, the odds of experiencing gout flares were pronounced among patients who received the Sinovac Life vaccine (adjusted OR, 3.13, 95 percent CI, 1.12–8.72) and those with elevated serum urate levels prior to receipt of the first dose (adjusted OR, 1.14, 95 percent CI, 1.02–1.27).

“Surprisingly, mention of gout, a disease so frequently linked with obesity, type 2 diabetes, hypertension, and advanced age, has been omitted from recent rheumatology society recommendations for COVID-19 vaccination in patients with rheumatic disease,” the investigators noted. [Lancet Rheumatol 2021;3:e317-318; Ann Rheum Dis 2020;79:851-858; Arthritis Rheumatol 2021;73:e1-12; Int J Rheum Dis 2020;23:717-722]

It has important implications, as “[t]he willingness to get vaccinated against COVID-19 in patients with rheumatic diseases is limited by the fear of vaccine side effects,” they added. [Rheumatology 2021;60:SI68-76]

The investigators believe that their study may inform discussions with patients with gout about the risks of flare-ups around the time of COVID-19 vaccination, as well as about the possibility of reducing this risk with prophylactic colchicine use.

More studies are needed to look into whether mRNA vaccines have the same effect, they said.