What is gout and why are cases of the historical condition on the rise?

Seeing Olivia Colman’s depiction of Queen Anne as she battled gout in ‘The Favourite’ might have you believing the condition is something purely confined to the history books, but in fact cases of the painful form of arthritis are on the rise right now.

The Times reports that hospital cases of gout have tripled since 2010 (65,387 in 2010, 165,734 in 2017-18).

According to Professor Anisur Rahman, Versus Arthritis spokesperson and professor of rheumatology at University College London, there is no single reason why so many of us are having to battle the historical ailment once again.

He suggests contributory factors could be changing dietary preferences – more obesity, higher red meat and alcohol consumption – and maybe more people taking diuretic drugs for things like high blood pressure, as these dietary and medication factors are known risk factors for gout.

But what exactly is gout and what else do we need to know about it?

What is gout?

“Gout is caused by small crystals of urate that deposit in joints and cause inflammation and irritation of the joint lining,” explains professor Rahman. “Imagine someone scattering salt inside your joint and think how irritating that would be.”

Though urate is a normal body constituent – we all have urate in our blood – if the level of urate rises to an excessive level, there is too much to stay dissolved and so some of it forms solid crystals.

“This can happen in various areas of the body, particularly under the skin and in joints. So the important thing is that gout is caused by having excessively high levels of urate,” professor Rahman adds.

Who gets gout?

According to the NHS gout sometimes runs in families and is more common in men, particularly as they get older.

But other people who are more at risk of suffering from the condition include women who have gone through the menopause, people who take medicines such as diuretics (water tablets) for blood pressure, or have high levels of cholesterol and those who are overweight and who drink alcohol, especially beer.

What are the signs and symptoms of gout?

“Typically, gout attacks happen in a single joint at a time – though some people get polyarticular gout (i.e. in multiple joints simultaneously),” explains professor Rahman.

He says the most common joint to be affected is the base of the big toe, but fingers are also a common site.

“In a typical gout attack, the big toe (or another joint) becomes very hot red, swollen and painful over a period of a few hours and stays that way for several days. Often the pain is so bad that it is hard to walk.

“Pain is the main feature of gout. But the attacks don’t usually last more than 1-2 weeks maximum. In severe cases, the attacks are frequent – but this not the case for most people. Some people also get little hard lumps of urate in the skin of the fingertips or earlobes. These lumps are called tophi.”

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How is gout treated?

According to Dr Colin Tench, a Consultant Rheumatologist at London Bridge Hospital (part of HCA UK)
there are three key ways to treat gout.

“Acute flares of gout are normally treated with a course of nonsteroidal anti-inflammatory drugs such as ibuprofen,” he explains. “Colchicine is an alternative option and sometimes patients can benefit from a steroid injection into the inflamed joint.”

He also says that weight loss and dietary modification can be helpful as well as reducing alcohol consumption.

“In patients with recurrent flares, the longer term treatment with medication to reduce the level of uric acid in the blood is very effective,” he continues. “First line treatment is usually with a drug called allopurinol which blocks the enzyme that produces uric acid and therefore prevents further attacks.”

Can you prevent gout?

The NHS has produced a list of do’s and don’ts to help prevent gout including trying to get to, then maintain a healthy weight (avoiding crash diets), having at least two alcohol-free days a week, exercising regularly and drinking plenty of fluids.

They also suggest reducing consumption of red meat, liver or seafood, avoiding sugary drinks and snacks and keeping alcohol intake to less than 14 units a week.