ОСОБЛИВОСТІ ПЕРЕБІГУ ПОДАГРИ ТА COVID-19 В УМОВАХ КОМОРБІДНОСТІ

Abstract

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.