Suddenly gout is on the rise – so why are so few patients getting the treatment they need?

An active young man in his twenties, Harry Tyndall was both shocked and terrified to wake up one morning with an intense stabbing pain in his right foot.

“It was the worst pain ever – I thought I had broken it. I couldn’t even walk, but I didn’t do anything to hurt it,” Harry, who was just 27 at the time, recalls.

A trip to the emergency room followed, where Harry was diagnosed with gout, a form of arthritis that causes sudden, severe joint pain and is often associated with older men paying the price for overeating rich foods and port.

“I thought gout had to do with too many good lives and older people – not men in their 20s,” admits Harry, who lives in South East London and works for a plumbing supply company.

New figures suggest that so-called ‘king’s disease’ is on the rise, and hospitalizations for gout are rising. It is thought that this increase is largely the result of lack of exercise and poor nutrition during successive lockdowns.

Cases are up 20 percent in three years, with 234,000 patients hospitalized with gout in 2021-22, according to figures released by the NHS last month.

New figures suggest that so-called ‘king’s disease’ is on the rise, and hospitalizations for gout are rising. This increase is thought to be largely the result of lack of exercise and poor nutrition during successive lockdowns [File photo]

About 1.5 million people in the UK are affected by this painful condition, according to the charity Arthritis UK.

Still, experts say that while lifestyle can trigger flare-ups, genetics play a bigger role in developing gout in the first place. For example, Harry’s father also had gout.

And it is feared that outdated perceptions of gout as both self-causing and transient are preventing thousands of people from getting drugs to prevent attacks.

‘There is a lack of awareness that it is inherently a genetic disease,’ says Dr Alastair Dickson, a GP and trustee of the UK Gout Society, who believes it is still seen as a Victorian condition, caused by excessive drinking and drinking. to eat.

As such, it is “misunderstood by many health professionals and the public,” he says, adding that for this reason, less than half of Britons with gout receive appropriate treatment.

The importance of this was underlined by research published last month in the Journal of the American Medical Association, which found that people with gout were more likely to have a heart attack or stroke in the four months after a flare-up than those without gout.

Scientists from the Universities of Nottingham and Keele, who followed 62,000 gout patients in the UK, said this is because the inflammation caused by the condition affects not only the joints but other parts of the body, including the arteries around the heart.

Gout – the most common form of inflammatory arthritis in the UK – is caused by a build-up in the blood and tissues of uric acid, which is released as a result of the breakdown of compounds called purines.

These occur naturally in the body, but are also found in certain foods, including tuna, beer, bacon and liver.

About 1.5 million people in the UK are affected by this painful condition, according to the charity Arthritis UK.  Still, experts say that while lifestyle can trigger flare-ups, genetics plays a bigger role in developing gout in the first place. [File photo]

About 1.5 million people in the UK are affected by this painful condition, according to the charity Arthritis UK. Still, experts say that while lifestyle can trigger flare-ups, genetics plays a bigger role in developing gout in the first place. [File photo]

Gout occurs when the kidneys cannot properly remove this uric acid. Uric acid crystals then form in joints and under the skin, leading to severe pain. Uric acid crystals in the kidneys can also lead to kidney stones and a severe reduction in kidney function. dr. Dickson says millions of people have excess uric acid in the blood but don’t have gout because they don’t have the genetic susceptibility.

But those who are genetically predisposed can develop full-blown gout if an environmental trigger — such as a virus — causes the immune system to identify the crystals as foreign bodies and trigger an inflammatory response.

Once primed, the immune system continues to attack the body, so long-term urate-lowering treatment is required.

Seizures are usually treated with the anti-inflammatory drug colchicine, or pain relievers, including ibuprofen.

The preventive drugs allopurinol and febuxostat (which lower uric acid levels) are recommended by the National Institute for Health and Care Excellence (NICE) for “multiple or troubling” flare-ups. NICE also recommends discussing these drugs, which cost just 28 cents per tablet, with all gout patients, as most will have future attacks without these drugs.

Yet a report in the journal Lancet Regional Health – Europe in May found that only a minority of UK patients receive preventive medication within 12 months of diagnosis.

One of the report’s authors, Dr. Mark Russell, NIHR researcher at King’s College London, told Good Health: ‘Without preventive treatment, flare-ups tend to become more frequent over time and can develop into chronic arthritis that never fully resolves.

rude health

Men who regularly indulge their sweet tooth may harm their fertility, reports the journal Reproductive Sciences.

A study of 300 men showed that sperm concentration was 15 percent lower in those who ate the most foods with added sugar — including pastries and ice cream — compared to those who ate the least.

It is thought that the high sugar content can damage DNA, which affects sperm movement and quality.

“Long-term treatment with urate-lowering drugs such as allopurinol prevents seizures and joint damage in people with gout and improves quality of life.”

dr. Dickson fears that many health care professionals don’t appreciate that, far from being a one-time episode that can be addressed by switching to a low-purine diet, for many patients, gout is a long-term chronic condition that requires careful treatment.

Fortunately for Harry Tyndall, his doctor promptly prescribed allopurinol after his ED visit in 2016.

It is thought that although Harry’s family history predisposed him to gout and despite being active, his poor diet at the time (he ate a lot of red meat and weighed 16 pcs) caused a full-blown attack.

The allopurinol helped reduce his symptoms, but came too late to prevent him from developing kidney stones.

Several days later, he collapsed with a burning stomach pain and was given medicine to dissolve the stones.

Now 34, he has changed his diet: he no longer eats red meat and has lost a stone.

“As long as I keep taking my allopurinol and I’m careful with my diet, there’s no reason to fear another flare-up,” Harry says. “But it makes me angry that people see gout as an ‘old’ condition, or something that greedy people get.

“Gout can affect anyone and we need to be more aware of that.”

ukgoutsociety.org

Under the microscope

England’s most capped male footballer, Peter Shilton, 73, takes our health quiz

Can you run up the stairs?

Not at the moment, as I had a left hip replacement in July. Before my hip started to hurt, I was running for 20 minutes every day. Once I’m recovered, I’ll start over.

Getting your five-a-day?

Yes. I used to eat more meat, but my wife [Steph Hayward, 54, a jazz singer whom he married in 2016] has changed my diet quite a bit, so I now eat more fruits and vegetables. I love carrots, Brussels sprouts, fresh cabbage and green beans.

Ever been on a diet?

Never. I only weigh about 7 pounds more than when I was playing. I am 1.80m and at the moment I am about 17st. I have quite a bit of muscle on me.

Any vices?

Gamble. I don’t know if my dad had a big win on the horses when I was young that triggered something, but I always liked it and it gave me a high. The real escalation came when online gambling arrived, which allowed me to sit in front of my computer and gamble for hours. Things only started to change when I met Steph in 2012. It wasn’t easy to stop.

England's most capped male footballer, Peter Shilton, 73, takes our health quiz

England’s most capped male footballer, Peter Shilton, 73, takes our health quiz

Any family issues?

My father died of a heart attack in 2015 at the age of 93. My mother contracted Alzheimer’s disease and died two years later. I get my big hands from her.

Worst injury?

I once split my eye at Wembley when I collided with Des Walker in March 1990 while playing against Brazil. It went to the bone and was the most painful experience of my life. My hip that needs to be replaced is the biggest thing that has physically gone wrong with me.

taking pills?

I take multivitamins every day for bone and muscle strength.

Ever had plastic surgery?

Not really. Obviously I have a younger wife so I need to keep fit, but I’d rather work out.

Coping well with pain?

I’m pretty good, but the last few months before my hip surgery I was in terrible pain. I don’t wish that on anyone.

Ever been depressed?

At the height of my gambling addiction, I was depressed. Playing football masked the impact of gambling, but when I stopped I felt much worse. Sometimes I would bet on the internet all day and not finish until 3 am. Slowly it dawned on me that I could lose Steph if I didn’t stop.

What keeps you up at night?

In general I am a good sleeper. People ask me if I have sleepless nights over the Maradona ‘hand of God’ goal at the 1986 World Cup in Mexico, but I don’t. If he hadn’t cheated, I would have had the ball.

Any phobias?

I really hate snakes.

Peter supports the 25th anniversary of GamCare (gamcare.org.uk).

Interview by Nick McGrath

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