King Henry VIII portrait at Longleat House, Wiltshire, UK / Rex

Gout diagnoses have doubled since 1990. It affects 1 in 40 adults in the UK, mainly men aged between 30 and 60

My medical school lecture on the subject of gout began with a picture of King Henry VIII – the archetypal king of excess. It’s therefore understandable that patients are surprised when diagnosed with a condition that could just as easily be associated with the modern diet. While gout has somehow retained its reputation as the “Disease of Kings”, the reality is that it doesn’t discriminate.

Gout is a disease caused by inflammation within a joint. A chemical in the blood called uric acid works to break down a substance called purine. If there is too much uric acid in the body, it crystallises to form deposits in the joints, tendons and tissues. These deposits cause the inflammation that we refer to as gout.

Excruciatingly painful

Gout diagnoses have doubled since 1990. It affects 1 in 40 adults in the UK, mainly men aged between 30 and 60. The big toe is the joint most commonly affected. Symptoms typically include a red, hot, swollen joint that is excruciatingly painful, often with a rapid onset. It can be difficult to determine if a patient is suffering from gout or an infection in the joint, as both appear quite similar. For that reason, patients should see their GP if symptoms develop.

Pain zones in a hand with gout

Information provided by the patient, along with clinical examination, is usually sufficient for a diagnosis. However, your doctor might need to perform some investigations to help confirm the diagnosis. These include taking a sample of fluid from the joint to look for crystal deposits or a blood test.

Gout can also present as a more chronic problem. Uric acid can form clumps called tophi, often in the tips of the ears, knuckles or within tendons and joints. When in a joint, they can cause damage to the bone and lead to chronic arthritis problems.

Genetics and diet play a significant role

There are many reasons why a patient might suffer from gout. Genetics play a significant role. Medication can also be a factor, with diuretic treatments that help eliminate excess fluid from the body being linked. If the body is not able to eliminate uric acid effectively, for example if the kidneys are not working efficiently, the risk of developing gout is higher. Other risk factors include a higher body mass index (BMI), stress, dehydration and joint trauma.

Diet plays a key role in increasing the chances of developing gout. Patients who drink alcohol above the recommended guidelines, particularly beer, should reduce their intake. Other links have been established with consumption of high fructose-sweetened drinks, meats including liver and kidney, and seafoods such as shellfish and sardines. These foods are generally high in purine. Patients with a history of gout should opt for low purine diets.


Treatment for gout

There are a number of treatment strategies for gout. They depend on whether patients are suffering from acute attacks of gout, chronic gout, or want to prevent further attacks of gout. Vitamin C can be effective in reducing the frequency of acute gout attacks, as can regular consumption of low-fat diary products such as skimmed milk. There is also evidence to suggest that coffee has a place in reducing gout attacks, although this comes with caution regarding monitoring caffeine intake. Lifestyle changes bring the most benefit: Things to consider include reducing how much alcohol you drink, ensuring a healthy BMI (although crash diets can worsen gout so should be avoided), ensuring adequate hydration, avoiding fructose-sweetened drinks and reducing overall purine intake.

Your GP can offer several treatments for gout. Patients are initially offered a non-steroidal anti-inflammatory medication, if permitted by their medical history. If this is not suitable or helpful, a specific treatment called colchicine is available, or a course of steroid medication may be offered. This should be used alongside pain relieving medication. Other simple measures, such as ice treatment for the affected joint, with elevation, and resting the joint, are encouraged. If you have had more than two attacks in a year, your GP may discuss a preventative treatment called allopurinol or febuxostat.

Without treatment, most acute attacks will last up to seven days.  Unfortunately, 60% of patients experience further attacks within a next year. Gout is no longer a “rich man’s disease”. Adopting a healthier, more balanced lifestyle can go a long way towards ensuring that you don’t have to suffer the pain of living like a king.

Dr Alexandra Phelan is an NHS GP and member of the Online Doctor Service team.