Colchicine prophylaxis is associated with fewer gout flares after COVID-19 vaccination

Abstract

ObjectivesCOVID-19 vaccination often triggers a constellation of transitory inflammatory symptoms. Gout is associated with several comorbidities linked to poor outcomes in COVID-19, and gout flares can be triggered by some vaccinations. We analysed the risk of gout flares in the first 3 months after COVID-19 vaccination with inactivated virus, and whether colchicine can prevent gout flares following post-COVID-19 vaccination.MethodsA clinical delivery population-based cross-sectional study was conducted in the Gout Clinic at the Affiliated Hospital of Qingdao University between February and October 2021. Study participants were selected using a systematic random sampling technique among follow-up patients with gout. We collected data, including vaccinations and potential risk factors, using a combination of interviews, health QR codes and medical records. Logistic regression was used to adjust for covariates.ResultsWe enrolled 549 gout participants (median age 39 years, 84.2% vaccinated). For the 462 patients who received COVID-19 vaccine, 203 (43.9%) developed at least one gout flare in the 3 months after vaccination. Most of these flares were experienced within 1 month after the first (99/119 (83.2%)) or second (70/115 (60.9%)) dose of vaccine. Compared with unvaccinated participants, COVID-19 vaccination was associated with higher odds of gout flare within 3 months (adjusted OR 6.02; 95% CI 3.00 to 12.08). Colchicine use was associated with 47% less likelihood of postvaccine gout flare.ConclusionCOVID-19 vaccination was associated with increased odds of gout flare, which developed mainly in month 1 after each vaccine dose, and was negatively associated with colchicine prophylaxis.

Risk of gout flares after COVID-19 vaccination: A case-crossover study

“…Recently, a cross-sectional study reported that inactivated COVID-19 vaccination was associated with a 6-fold higher odds of gout flares [9] . The inactivated COVID-19 vaccine in that study contains aluminum hydroxide adjuvant, and previous studies have shown that adjuvant could activate the inflammatory cascade, resulting in an increased risk of gout flares [ 23 , 24 ].…”

“…These findings have prompted the implementation of an enhanced post-marketing surveillance program for gout flares following vaccination [8] . Recently, a study showed that the odds of gout flares increased by almost 6-fold after receiving the inactivated COVID-19 vaccines [9] . However, whether the risk of gout flares increases after receiving other COVID-19 vaccines, such as messenger RNA (mRNA) vaccines BNT162b2 (Pfizer–BioNtech, hereafter referred to as BNT) or adenovirus vector vaccines ChAdOx1 nCov-19 (Oxford–AstraZeneca; hereafter referred to as ChAd) is unknown.…”

What Should We Do after the COVID-19 Vaccination? Vaccine-Associated Diseases and Precautionary Measures against Adverse Reactions

“…Abnormal menstrual cycles (delayed menstruation or increased bleeding or pain) [106], anaphylaxis [44], gout flares [48], lymphadenopathy [107,108], rhabdomyolysis [109], shoulder injuries related to vaccine administration (SIRVA) [109,110], and Vogt-Koyanagi-Harada syndrome [19] have also been reported following COVID-19 vaccination (Table 1). SIRVA is an acute inflammation of the shoulder that causes substantial shoulder pain and a limited range of motion [109,110].…”

“…NLRP3 inflammasome is associated with IL-1β secretion. Colchicine has the effect of suppressing the formation of NLRP3 inflammasome [47], which may be useful for vaccine-associated inflammation [48]. The mRNA vaccines increase both immunostimulatory cytokines release and inflammatory cytokines release, especially after the second vaccination and in patients infected by SARS-CoV-2 [10].…”

“…In severe cases, steroids may be effective in pre venting cytokine release, autoimmunity, and eosinophilic myocarditis [20]. Colchicine which has an inhibitory effect on the NOD-like receptor family pyrin domain containing 3 (NLRP3) inflammasome, which is associated with IL-1β (inflammatory cytokine) secre tion [47], may be also effective for vaccine-associated inflammation [48].…”