Arthritis & Rheumatism, Volume 60,
October 2009 Abstract Supplement

The 2009 ACR/ARHP Annual Scientific Meeting
Philadelphia October 16-21, 2009.

Risk of Recurrent Gout After Acute Infection and Vaccination: The Online Case-Crossover Gout Study

Zhang1,  Yq., Chen1,  C., Neogi1,  T., Chaisson1,  C., Choi2,  Hyon K., Hunter3,  David J.

BUSM, Boston, MA,
Boston University School of Medicine, Boston, MA,
New England Baptist Hospital, Boston, MA


Acute infection induces a systematic inflammatory response, which may act as a precipitant of pro-inflammatory stimuli to trigger recurrent gout attacks. Similarly, vaccination could trigger pro-inflammatory stimuli and increase the risk of recurrent gout. Furthermore, acute infection and vaccination could lead to fever and dehydration, which may also trigger recurrent gout. We evaluated the risk of recurrent gout after acute infection and vaccination in the Online Case-Crossover Gout Study.


The Online Case-Crossover Gout Study is a self-controlled prospective study to assess a set of putative risk factors triggering recurrent gout attacks. Subjects who had experienced a gout attack within the past year were recruited online and were asked to provide access to medical records for verification of gout diagnosis. Subjects were asked to log onto the study website when they experienced a gout attack. Risk factors, including acute infection and vaccination occurring each day over the two-day period prior to an acute gout attack (case-period) were assessed using an online questionnaire. The same questionnaire was used over each of the two days during an intercritical period (control-period). We examined the relation of acute infection and vaccination over the 2-day period to the risk of recurrent gout attacks using conditional logistic regression adjusting for alcohol consumption, purine intake, and diuretic use.


Include in this analysis were 535 subjects who experienced recurrent gout attacks during the study period. Participants were predominantly white (89%) and male (78%), and 58% had a college education. Of the 517 medical records obtained to date, 76% fulfilled ACR criteria for a gout diagnosis. The median time between the onset of gout attack and logging on to the website was 2 days. The proportions of acute infection and vaccination were 6.4% and 1.0%, respectively, over the control-periods. The corresponding proportions were 10.1% and 2.6% over the case-periods. Acute infection and vaccination were associated with an increased risk of recurrent gout attacks, with adjusted odds ratios of 1.7 (95% CI: 1.2–2.4) and 5.3 (95% CI: 1.4–19.6), respectively

Triggers (over 2-day period)Control-periodsCase-periodsAdjusted OR (95% CI)
No123310091.0 (reference)
Yes841131.7 (1.2–2.4)
No7766401.0 (reference)
Yes8175.3 (1.4–19.6)
* Data were collected in the late phase of the study


Acute infection and vaccination increase the risk of recurrent gout attacks among gout patients. Our findings provide support for the concept that acute infection and immunization act as precipitants of pro-inflammatory stimuli or dehydration to trigger recurrent gout attacks.

To cite this abstract, please use the following information:
Zhang, Yq., Chen, C., Neogi, T., Chaisson, C., Choi, Hyon K., Hunter, David J.; Risk of Recurrent Gout After Acute Infection and Vaccination: The Online Case-Crossover Gout Study [abstract]. Arthritis Rheum 2009;60 Suppl 10 :1500
DOI: 10.1002/art.26574

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