Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, MA, United States.
Arthritis Research Centre of Canada, Richmond, Virginia, Canada.
Ann Rheum Dis. 2019 Nov;78(11):1601-1604. doi: 10.1136/annrheumdis-2019-215724. Epub 2019 Jul 31.
The recombinant zoster vaccine (RZV) containing a strong non-aluminium adjuvant is associated with increased risk of gout flares, presumably via NLRP3 inflammasome activation. We tested the possibility that other vaccines may also be associated with gout flares.
We conducted an online case-crossover study of patients with gout to examine the association between vaccination and gout flares. We collected information through the Internet on exposures to potential risk factors, including vaccinations, during 2-day hazard periods prior to gout flare and 2-day control periods without a flare. Conditional logistic regression was used to adjust for covariates.
There were 517 participants with gout (mean age 55 years, 79% male) who experienced gout flares during follow-up. There were 28 vaccinations during 990 hazard periods and 21 vaccinations during 1407 control periods. Vaccination was associated with twofold higher odds of gout flare (adjusted OR 1.99; 95% CI 1.01 to 3.89).
Our findings suggest vaccines other than RZV are associated with increased odds of gout flares, potentially through a shared pathogenetic mechanism like NLRP3 inflammasome. However, the absolute magnitude of increased odds of gout flares with vaccinations remains small and must be interpreted within the context of the overwhelming benefits of vaccinations.
含强效非铝佐剂的带状疱疹重组疫苗（RZV）与痛风发作风险增加相关，推测其机制可能与 NLRP3 炎性小体激活有关。我们检验了其他疫苗也可能与痛风发作相关的可能性。
我们对痛风患者进行了一项在线病例交叉研究，以检验接种疫苗与痛风发作之间的关联。我们通过互联网收集了发病前 2 天危险期和无发作 2 天对照期内暴露于潜在危险因素（包括疫苗接种）的信息。采用条件逻辑回归对协变量进行调整。
在随访期间，有 517 名痛风患者（平均年龄 55 岁，79%为男性）发生了痛风发作。在 990 个危险期中有 28 次接种，在 1407 个对照期中有 21 次接种。接种与痛风发作的几率增加两倍相关（调整后的 OR 1.99；95%CI 1.01 至 3.89）。
我们的研究结果表明，除 RZV 以外的疫苗与痛风发作的几率增加相关，可能通过 NLRP3 炎性小体等相似的发病机制。然而，接种疫苗后痛风发作几率增加的绝对幅度仍然较小，必须在疫苗接种带来的巨大益处的背景下进行解释。
