• Svitlana Smiyan Department of Internal Medicine No. 2, Ivan Horbachevsky Ternopil National Medical University of the Ministry of Health of Ukraine, Ternopil, Ukraine
  • Olha Makhovska Department of Internal Medicine No. 2, Ivan Horbachevsky Ternopil National Medical University of the Ministry of Health of Ukraine (TNMU), Ternopil, Ukraine
Keywords: gout, hyperuricemia, uric acid, goals, prevalence, risk, comorbidity, COVID-19


Introduction. Comorbid diseases signifi cantly exacerbate gout burden, represent an even more elevated risk of hospitalization and mortality rates owing to the coronavirus disease 2019 (COVID-19) than gout itself.

Objectives. To evaluate the infl uence of the modifi ed Rheumatic Disease Comorbidity Index (mRDCI) on the clinical course of gout and COVID-19.

Methods. Using data from 136 male participants with gout, we distributed the cohort according to values of the mRDCI as follows: 0 – without comorbidities, 1-2 – low comorbidity index (CI), 3-4 – moderate CI and ≥5 – high CI. “Treat-to-target” approach for gout, the association of mRDCI with the clinical course of gout, lipid metabolism, and severity of COVID-19 were analyzed.

Results. According to mRDCI scores, almost every second gout patient (45.6%) had moderate CI, every fi fth (19.1%) – high CI, and 14.7% – low CI. Greater mRDCI was associated with the higher severity of COVID-19 (p=0.003), limited physical functioning (r=0.5, p<0.001), higher body mass index (r=0.63, p<0.001), hyperuricemia (r=0.37, p<0.001), increased low–density lipoprotein cholesterol (LDL–C) (r=0.38, p<0.001),

higher gout activity (r=0.4, p<0.001), more frequent acute fl ares in the preceding year (r=0.39, p<0.001), number of tophi (r=0.31, p<0.001), longer duration of gout (r=0.34, p<0.001), reduced glomerular fi ltration rate (r =–0.39, p<0.001), and daily excretion of uric acid (UA) (r=–0.28, p=0.001). The target level of serum UA was achieved in 22.1%. The majority of patients were not controlled for LDL-C (83.7%), blood pressure (75.5%), and glucose (69.44%) in the cohort with dyslipidemia, hypertension, and diabetes respectively.

Conclusion. The high prevalence of comorbidities in gout patients was associated with the severity of COVID-19. We have established the following three patterns of comorbidity predictors: anthropometric, disease-related, and dysmetabolic. The management of gout requires a multidisciplinary approach.


Download data is not yet available.


Dehlin M, Jacobsson L, Roddy E. Global epidemiology of gout: prevalence, incidence, treatment patterns and risk factors. Nat Rev Rheumatol [Internet]. 2020;16(7):380-90. Available from: http://dx.doi. org/10.1038/s41584-020-0441-1

Kuo CF, Grainge MJ, Mallen C, Zhang W, Doherty M. Rising burden of gout in the UK but continuing suboptimal management: A nationwide population study. Ann Rheum Dis. 2015;74(4):661-7.

Trifirò G, Morabito P, Cavagna L, Ferrajolo C, Pecchioli S, Simonetti M, et al. Epidemiology of gout and hyperuricaemia in Italy during the years 2005-2009: A nationwide population-based study. Ann Rheum Dis. 2013;72(5):694-700.

Bardin T, Bouée S, Clerson P, Chalès G, Flipo RM, Lioté F, et al. Prevalence of Gout in the Adult Population of France. Arthritis Care Res. 2016;68(2):261-6.

Zhu Y, Pandya BJ, Choi HK. Prevalence of gout and hyperuricemia in the US general population: The National Health and Nutrition Examination Survey 2007-2008. Arthritis Rheum. 2011;63(10):3136-41.

Kuo CF, Grainge MJ, See LC, Yu KH, Luo SF, Zhang W, et al. Epidemiology and management of gout in Taiwan: A nationwide population study. Arthritis Res Ther. 2015;17(1):1-10.

Elfishawi MM, Zleik N, Kvrgic Z, Michet CJ, Crowson CS, Matteson EL, et al. The rising incidence of gout and the increasing burden of comorbidities: A population-based study over 20 years. J Rheumatol. 2018;45(4):574-9.

Manoilenko T, Dorohoi A, Handziuk V, Al. E. Khvoroby systemy krovoobihu yak medyko-sotsialna i suspilno-politychna problema, Kovalenko V, Kornatskyi V (eds.). NAMN Ukrainy, DU "NNT "In-t kardiolohii im. MD Strazheska", Kyiv 2014.

Dachenko L, Manoilenko T, Revenko I, Dorokhina H, Handziuk V, Bieliaieva T. Stan zdorovia narodu Ukrainy za 2014-2017 roky. In: Aktualni problemy zdorovia ta minimizatsiia yikh v umovakh zbroinoho konfliktu v Ukraini, Kovalenko V, Kornatskyi V (eds.). NAMN Ukrainy, DU "NNT "In-t kardiolohii im. MD Strazheska", Kyiv 2018: 165-166.

Shields GE, Beard SM. A Systematic Review of the Economic and Humanistic Burden of Gout. Pharmacoeconomics. 2015;33(10):1029-47.

Wu M, Tian Y, Wang Q, Guo C. Gout: a disease involved with complicated immunoinflammatory responses: a narrative review. Clin Rheumatol. 2020;39(10):2849-59.

Kawamura Y, Nakaoka H, Nakayama A, Okada Y, Yamamoto K, Higashino T, et al. Genome-wide association study revealed novel loci which aggravate asymptomatic hyperuricaemia into gout. Ann Rheum Dis. 2019;78(10):1430-7.

Khanna PP, Nuki G, Bardin T, Tausche AK, Forsythe A, Goren A, et al. Tophi and frequent gout flares are associated with impairments to quality of life, productivity, and increased healthcare resource use: Results from a cross-sectional survey. Health Qual Life Outcomes. 2012;10:1-11.

Zhu Y, Pandya BJ, Choi HK. Comorbidities of Gout and Hyperuricemia in the US General Population : NHANES 2007-2008. AJM [Internet]. 2012;125(7):679-687.e1. Available from: http://dx.doi. org/10.1016/j.amjmed.2011.09.033

Williamson EJ, Walker AJ, Bhaskaran K, Bacon S, Bates C, Morton CE, et al. Factors associated with COVID-19-related death using OpenSAFELY. Nature [Internet]. 2020;584(7821):430-6. Available from:

Disveld IJM, Zoakman S, Jansen TLTA, Rongen GA, Kienhorst LBE, Janssens HJEM, et al. Crystal- proven gout patients have an increased mortality due to cardiovascular diseases, cancer, and infectious diseases especially when having tophi and/or high serum uric acid levels: a prospective cohort study. Clin Rheumatol. 2019;38(5):1385-91.

Ahmed S, Gasparyan AY, Zimba O. Comorbidities in rheumatic diseases need special consideration during the COVID-19 pandemic. Rheumatol Int [Internet]. 2021;41(2):243-56. Available from: https://

Dalbeth N, Robinson PC. Patients with gout: an under-recognised group at high risk of COVID-19. Lancet Rheumatol [Internet]. 2021 Mar [cited 2021 Apr 7];3(5):317-8. Available from: https://linkinghub.

Neogi T, Jansen TLTA, Dalbeth N, Fransen J, Schumacher HR, Berendsen D, et al. 2015 Gout classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Ann Rheum Dis. 2015;74(10):1789-98.

World Health Organization. Global database on body mass index. 2004. Available from: http://www.

Stevens PE, Levin A. Evaluation and management of chronic kidney disease: Synopsis of the kidney disease: Improving global outcomes 2012 clinical practice guideline. Ann Intern Med. 2013;158(11):825-30.

La-Crette J, Jenkins W, Fernandes G, Valdes A, Doherty M, Abhishek A. First validation of the gout activity score against gout impact scale in a primary care based gout cohort. Jt Bone Spine [Internet]. 2018;85(3):323-5. Available from:

Bruce B, Fries JF. The Stanford Health Assessment Questionnaire : Dimensions and Practical Applications. Health Qual Life Outcomes. 2003;1:20:1-6.

Kroenke K, Spitzer RL, Williams JBW. The PHQ-9: Validity of a brief depression severity measure. J Gen Intern Med. 2001;16(9):606-13.

Michaud K, Wolfe F. Comorbidities in rheumatoid arthritis. Best Pract Res Clin Rheumatol. 2007;21(5):885-906.

Spaetgens B, Wijnands JMA, van Durme C, Boonen A. Content and construct validity of the Rheumatic Diseases Comorbidity Index in patients with gout. Rheumatol (United Kingdom). 2015;54(9):1659-63.

Unger T, Borghi C, Charchar F, Khan NA, Poulter NR, Prabhakaran D, et al. 2020 International society of hypertension global hypertension practice guidelines. J Hypertens. 2020;38(6):982-1004.

Mach F, Baigent C, Catapano AL, Koskinas KC, Casula M, Badimon L, et al. 2019 ESC/EAS Guidelines for the management of dyslipidaemias: Lipid modification to reduce cardiovascular risk. Eur Heart J. 2020;41(1):111-88.

American Diabetes Association. Glycemic Targets: Standards of Medical Care in Diabetes-2021. Diabetes Care. 44(Suppl 1):S73-84.

World Health Organization. COVID-19 clinical management: living guidance, 25 January 2021. World Health Organization. Available on

Oh Y-J, Moon KW. Combined Use of Febuxostat and Colchicine Does Not Increase Acute Hepatotoxicity in Patients with Gout: A Retrospective Study. J Clin Med. 2020;9(5):1488.

Koto R, Nakajima A, Horiuchi H, Yamanaka H. Real-world treatment of gout and asymptomatic hyperuricemia: A cross-sectional study of Japanese health insurance claims data. Mod Rheumatol [Internet]. 2020;31(1):261-9. Available from:

Chen-Xu M, Yokose C, Rai SK, Pillinger MH, Choi HK. Contemporary Prevalence of Gout and Hyperuricemia in the United States and Decadal Trends: The National Health and Nutrition Examination Survey, 2007- 2016. Arthritis Rheumatol. 2019;71(6):991-9.

Kennedy NJ, Healy PJ, Harrison AA. Inpatient management of gout in a New Zealand hospital: A retrospective audit. Int J Rheum Dis. 2016;19(2):205-10.

Coburn BW, Bendlin KA, Sayles H, Hentzen KS, Hrdy MM, Mikuls TR. Target Serum Urate: Do Gout Patients Know Their Goal? Arthritis Care Res. 2016;68(7):1028-35.

Memon R, Levitt D, Salgado Nunez del Prado SR, Munir K, Lamos E. Knowledge of Hemoglobin A1c and Glycemic Control in an Urban Population. Cureus. 2021;13(3):e13995.

Wu Z, McGoogan JM. Characteristics of and Important Lessons From the Coronavirus Disease 2019 ( COVID-19 ) Outbreak in China Summary of a Report of 72 314 Cases From the Chinese Center for Disease Control and Prevention. JAMA. 2020;323(13):2039-42.

Chapron A, Chopin T, Esvan M, Ea HK, Lioté F, Guggenbuhl P. Non-pharmacologic measures for gout management in the prospective GOSPEL cohort: Physicians' practice and patients' compliance profiles. Jt Bone Spine [Internet]. 2019;86(2):225-31. Available from: jbspin.2018.06.013

Scheepers LEJM, Burden AM, Arts ICW, Spaetgens B, Souverein P, De Vries F, et al. Medication adherence among gout patients initiated allopurinol: A retrospective cohort study in the Clinical Practice Research Datalink (CPRD). Rheumatol (United Kingdom). 2018;57(9):1641-50.

Yin R, Li L, Zhang G, Cui Y, Zhang L, Zhang Q, et al. Rate of adherence to urate-lowering therapy among patients with gout: A systematic review and meta-analysis. BMJ Open. 2018;8(4):1-10.

Edwards NL, Schlesinger N, Clark S, Arndt T, Lipsky PE. Management of Gout in the United States: A Claims‐based Analysis. ACR Open Rheumatol. 2020;2(3):180-7.

Annemans L, Spaepen E, Gaskin M, Bonnemaire M, Malier V, Gilbert T, et al. Gout in the UK and Germany: Prevalence, comorbidities and management in general practice 2000-2005. Ann Rheum Dis. 2008;67(7):960-6.

Ragab G, Elshahaly M, Bardin T. Gout: An old disease in new perspective - A review. J Adv Res [Internet]. 2017;8(5):495-511. Available from:

Reynolds, RJ, Irvin, MR, Bridges S et al. Genetic correlations between traits associated with hyperuricemia, gout, and comorbidities. Eur J Hum Genet. 2021;

Liang CW, Islam MM, Poly TN, Yang HC, Jack Li YC. Association between gout and cardiovascular disease risk: A nation-wide case-control study. Vol. 86, Joint Bone Spine. Elsevier Masson SAS; 2019. p. 389-91.

Francis-Sedlak M, LaMoreaux B, Padnick-Silver L et al. Characteristics, Comorbidities, and Potential Consequences of Uncontrolled Gout: An Insurance- Claims Database Study. Rheumatol Ther [Internet]. 2021;8(1):183-97. Available from:

Karis E, Crittenden DB, Pillinger MH. Hyperuricemia, gout, and related comorbidities: cause and effect on a two-way street. South Med J. 2014 Apr;107(4):235-41.

Abstract views: 110
PDF Downloads: 78
How to Cite
Smiyan S, Makhovska O. COMORBIDITY AND ITS IMPACT ON THE COURSE OF GOUT AND COVID-19. Proc Shevchenko Sci Soc Med Sci [Internet]. 2022Jun.27 [cited 2022Oct.7];66(1). Available from: