Covid and gout: An unhealthy combination
As Mexico City went into lockdown during the Covid pandemic, Dr Juan García-Maturano and his colleagues at the Hospital General de Mexico’s rheumatology clinic had to find a way to take care of their gout patients. Many of their consultations moved to the phone, while some patients still made it to the clinic. Over the following year, Dr García-Maturano and his team were able to document the combined effects of lockdown, Covid and gout on their patients. It proved to be an unhealthy combination.
Before the pandemic, in their clinic, they would expect 4% of their patients (1 in 25) to be having a gout flare-up or just getting over one. During the pandemic, this rate rocketed to 35%, more than 1 in 3. Their patients were having nine times more gout attacks than before the pandemic.
Gout occurs when poorly soluble monosodium urate crystals are deposited in joints, kidneys, the skin and elsewhere. Levels of uric acid in the blood are used to measure how much urate is present in the body. The higher the levels, the higher the risk of gout attacks. During the pandemic, the average uric acid level of the clinic’s patients rose by a fifth, pushing them well into the range where gout attacks occur more frequently, and urate crystals form in tissues, storing up problems for the future.
Uric acid levels increased even further in those patients who had had Covid infection. On average, they were 54% higher than before the pandemic.
Being on restricted activities quickly plays havoc with our bodies
Numerous studies have shown how fast immobility can start to affect the body. Even healthy, fit young men lost lean body mass after just two weeks of relative immobility. They also laid down fat around their internal organs, and developed biochemical abnormalities. During the pandemic, most of us were locked down for months. Many of us over-ate during the lockdown, out of boredom and because the kitchen was just steps away. Not only that, infrequent shopping trips meant that the food in the kitchen tended to be less healthy. Most of us ate less fresh fruit and vegetables and more snacks and convenience meals, not to mention all the takeaways. These lifestyle changes likely led to the massive rise in gout attacks.
The risk of having a gout flare-up wasn’t all Dr García-Maturano’s patients had to worry about. They were also at a higher risk of contracting Covid and having more severe disease. Eight percent of the clinic patients caught Covid infection, and two died. Although the numbers are low, that’s still a fatality rate more than double that of fellow Mexicans. Covid and gout make for a dangerous combination.
Unexpected improvements
Despite the significant increase in gout flares and risk of severe Covid infection, the gout clinic patients reported improvements. On average, mobility, pain and discomfort, their ability to conduct daily activities, and levels of anxiety and depression all improved. These surprising results contrast with a survey conducted through the US Gout Education Society website.
In this US-based study, almost half the patients reported gout-related pain, difficulty performing household tasks or work, and challenges with engaging in social activities during the pandemic. Thirty-five percent of them reported moderate to severe psychological distress.
As in Mexico City, gout flare-ups were a problem, with 63% reporting one or more monthly flare-ups through the pandemic. Interestingly, almost half the patients said they took their allopurinol more regularly than before. Allopurinol is the medicine most commonly used to lower the body’s urate level and reduce the risk of gout attacks. Whether this was in response to frequent flare-ups or simply because people were stuck at home with fewer distractions is not known.
Similarly, in the UK, although the number of new gout diagnoses remained stable during the pandemic, the number of prescriptions for urate-lowering medicines like allopurinol increased. This may reflect people’s gout becoming less well controlled during the lockdown.
Can Covid vaccine trigger gout?
Given the increased risk of severe Covid infection or even death in people with gout, it is vital that they are vaccinated against Covid. Some people were concerned after a Chinese study showed that certain Covid vaccines trigger gout. Patients there had a six-fold higher risk of a gout attack over the next three months – most occurring in the first month after Covid vaccination. However, this was related to a Chinese Covid vaccine made from inactivated virus, which is very different from the mRNA vaccines used in the West.
A review of GP records in the UK showed a modest increase in gout attacks occurring on the second day after the Astra-Zeneca Oxford vaccine, but not the Pfizer-BioNTech vaccine. The likely explanation is that inflammation triggered by the immune response to the vaccine can increase inflammation in gout-affected joints. This aggravation of inflammation at a distant site is the same mechanism through which gum disease and gout attacks can lead to heart attacks.
Anyone with gout concerned about whether to have the Covid vaccine must weigh up the small increased risk of a flare-up with certain vaccines with that of severe or even fatal Covid infection. They should talk to their doctor about the advisability of a vaccine, and which one to have.
What can you do to reduce the risk of gout attacks in times of restricted mobility?
Whilst we can hope that Covid pandemic lockdowns are a thing of the past for most of us, there are steps you can take to reduce the risks of a gout flare-up should you be confined to home for any reason.
- Take your medication regularly and make sure you order repeat prescriptions in time.
- Keep well hydrated. Men should drink three litres of fluids a day, two and a quarter for women.
- Be careful what you drink. Drinks sweetened with sugar, especially high fructose corn syrup, can significantly push up urate levels.
- Keep alcohol consumption to a minimum.
- Keep your purine consumption low, and don’t over-eat. Being overweight increases the risk of gout attacks.
- Find a way to get regular exercise.
- Keep a treatment pack on hand in case you do get a gout flare-up.
- Know how your doctor or clinic wants you to get in touch in case you need help from them.
If you found this information useful, please have a look at The Gout & Pseudogout Handbook which is packed with similar information.
The Pocket Doctor Handbooks are designed to give you the knowledge and facts you need to talk confidently with your doctor to ensure you get the best treatment.
