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Suddenly gout is on the rise – so why do so few patients get the treatment they need?

New figures suggest the so-called 'sickness of kings' is on the rise, with hospital admissions for gout rising.  This increase is believed to be largely due to lack of exercise and poor diet during successive lockdowns. [File photo]

As an active young man in his 20s, Harry Tyndall was shocked and frightened to wake up one morning with intense stabbing pain in his right foot.

‘It was the worst pain of my life, I thought I had broken it. He couldn’t even walk, but I hadn’t done anything to hurt him,” recalls Harry, then only 27 years old.

A trip to A&E 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 overindulging in rich food and port.

“I thought gout was about the good life and older people, not men in their 20s,” admits Harry, who lives in south-east London and works for a plumbing delivery company.

New figures suggest the so-called ‘sickness of kings’ is on the rise, with hospital admissions for gout rising. This increase is believed to be largely due to lack of exercise and poor diet during successive lockdowns.

The number of cases has risen 20 per cent in three years, with 234,000 patients hospitalized with gout in 2021-22, according to figures released last month by the NHS.

New figures suggest the so-called 'sickness of kings' is on the rise, with hospital admissions for gout rising.  This increase is believed to be largely due to lack of exercise and poor diet during successive lockdowns. [File photo]

New figures suggest the so-called ‘sickness of kings’ is on the rise, with hospital admissions for gout rising. This increase is believed to be largely due to lack of exercise and poor diet during successive lockdowns. [File photo]

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

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

And it is feared that outdated perceptions of gout as self-inflicted and transient prevent thousands of people from receiving medication to prevent attacks.

“There’s a lack of awareness that it’s inherently a genetic disease,” says Dr Alastair Dickson, a GP and trustee of the UK Gout Society, who believes it’s still considered a Victorian condition, caused by excess of food and drink.

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 adequate treatment.

The importance of this was underscored 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 within four months of a flare-up than people without gout.

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

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

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

Around 1.5 million people in the UK are affected by this agonizing condition, according to the Arthritis UK charity.  However, experts say that while lifestyle can trigger flare-ups, genetics play a bigger role in who develops gout in the first place. [File photo]

Around 1.5 million people in the UK are affected by this agonizing condition, according to the Arthritis UK charity. However, experts say that while lifestyle can trigger flare-ups, genetics play a bigger role in who develops gout in the first place. [File photo]

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

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

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

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

The preventative drugs allopurinol and febuxostat (which lower uric acid levels) are recommended by the National Institute for Health and Care Excellence (NICE) for “multiple or troublesome” flare-ups. NICE also recommends that these drugs, which cost as little as 28p a tablet, be discussed with all gout patients, as most will suffer future attacks without them.

However, a report published 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, an NIHR researcher at King’s College London, told Good Health: “Without preventative treatment, flare-ups tend to become more frequent over time and can develop into chronic arthritis. that is never fully resolved.

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rude health

Men who regularly indulge in their sweet tooth could be harming 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 containing added sugar, including cakes and ice cream, compared to those who ate the least.

It is believed that the high sugar content can damage DNA, affecting sperm movement and quality.

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

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

Fortunately for Harry Tyndall, his doctor quickly prescribed allopurinol after his visit to A&E in 2016.

It is believed 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 pounds) triggered a full blown attack.

The allopurinol helped her symptoms subside, but it came too late to prevent her from developing kidney stones.

He collapsed several days later with severe stomach pains and was given medication to dissolve the stones.

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

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

Gout can affect anyone and we must be more aware of it.

ukgoutsociety.org

under the microscope

England’s most capped male footballer, Peter Shilton, 73, answers 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 hurting, I used to do 20-minute runs every day. Once I recover, I’ll start over.

Get 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] My diet has changed quite a bit, so now I eat more fruits and vegetables. I love carrots, Brussels sprouts, fresh cabbage, and green beans.

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Have you ever dieted?

Never. I’m only about 7 pounds heavier than when I was playing. I’m 6ft 1in and right now I’m 17. I have a little muscle on me.

Any vice?

Play. I don’t know if seeing my dad have a big victory in the horses when he was young triggered something, but I always liked him and he moved me. The real escalation came when online betting came along, allowing me to sit in front of my computer and gamble for hours. Things started to change when I met Steph in 2012. It wasn’t easy to stop.

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

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

Any family ailment?

My dad died of a heart attack, aged 93, in 2015. My mom got Alzheimer’s and passed away two years later. I take my big hands off of her.

Worst injury?

I broke my eye once at Wembley when I collided with Des Walker while playing Brazil in March 1990. It was bone deep and it was the most painful experience of my life. The need to replace my hip has been the most serious thing that has physically failed me.

Take any pills?

I take multivitamins every day to strengthen my bones and muscles.

Have you ever had plastic surgery?

No way. Obviously I have a younger wife so I have to keep fit, but I prefer to go to training.

Bear pain well?

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

Have you ever been depressed?

At the height of my gambling addiction, I was depressed. Playing football masked the impact of the game, but when I stopped I felt much worse. Sometimes I played on the Internet all day and didn’t finish until 3 am. I slowly began to realize that I might lose Steph if he didn’t stop me.

What keeps you awake at night?

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

Any phobia?

I really hate snakes.

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

Interview by Nick McGrath

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