The new goutists: Unfashionable? Definitely. Painful? Highly. Funny? Hilarious . . . unless you happen to be the one who has the gout, says our Political Correspondent Paul Routledge

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Indy Lifestyle Online
WHEN I rang the British Medical Association for information on gout, a young man in the press office sniggered. 'Gout? That's what politicians get from drinking too much red wine, isn't it?' At least, so his history textbooks at school had told him. This response is about par for the course. Tell anybody you are suffering from gout, and they burst into laughter. At the office, they tell me, I am known as Goutledge. Ha, ha.

My latest attack of gout, easily the worst in almost 20 years of suffering, came after enjoying the justly famous hospitality of my friends the Rawlings in deepest Littondale, north Yorkshire. On New Year's morning, I woke up with only a mild hangover. But my right ankle was swollen and extremely painful. I could walk only with the greatest difficulty.

Never fear, help was at hand. We goutists never go anywhere without an emergency supply of Naproxen, the vivid yellow bombers guaranteed to get rid of an attack within a day - or two, at most.

Gout, doctors tell us, is caused by the deposition of monosodium urate crystals in the joints. These build up when there is an excess of uric acid in the blood, which the body cannot excrete. Being relatively insoluble, the uric acid crystallises and forms deposits, usually in the extremities - usually the big toe or ankle, sometimes the fingers or wrist. These crystals are excruciatingly painful, and down the years gout has had an understandably bad press.

John Webster, the Elizabethan dramatist, wrote in The Devil's Law Case, circa 1619: 'one I have heard of in England / Was cured of the gout by being wracked i' the Tower'. Happily, this remedy is not available today. For me Naproxen usually does the trick. But not this time. The ankle continued to swell alarmingly, and the pain moved into unexplored regions.

Getting ill in the middle of a public holiday, 200 miles from one's GP, is not to be recommended. But the staff at Airedale hospital, near Keighley, were very understanding. They X-rayed the joint to make sure I hadn't broken my ankle, though I think I would have known about that. Then they gave me an injection of something or other per rectum, and bandaged up the offending limb. Swift was familiar with this procedure, commending 'patience and flannel for the gout' in 1738. Thankful for the hospital's solicitude, I was discharged full of hope into a wild Yorkshire night.

It did not work. The pain, accurately described by the physician Thomas Sydenham 300 years ago as 'violent, stretching, gnawing . . . so exquisite that it cannot bear the weight of bedclothes', continued. I tried to carry on as usual, travelling round the West Riding doing interviews for a biography of Betty Boothroyd. I must have cut a ludicrous figure limping out of the rain, walking stick in one hand and notebook in the other. At least it gave me an opening gambit.

Back home in west London, my amiable GP poked and prodded the swelling and sent me off to West Middlesex Hospital for blood tests. There, a kindly Irish nurse took what seemed enough blood to start a black sausage factory, while admiring the Yorkshire rose tattoo on my forearm. It doesn't get admired much: it's not even a proper Tyke rose, because it was done at Big Pete and Painless Max Chatter's salon in Sydney. Much cheered up, I half- ran, half-hobbled for the 237 bus to get me to Gunnersbury Tube. This was a great mistake. The ankle was very angry, and hurt like hell the whole day.

Some days later, the hospital tests showed that my uric acid level was 0.51. In a normal person it is between 0.0 and 0.40. My GP decided that something stronger was required, and prescribed Indomethacin four times a day. This is a non- steroid, anti-inflammatory drug, developed in recent years. When my GP began practising, such drugs did not exist. Doctors still relied on the old apothecary's standby of colchicum, an extract of the autumn crocus. Thought to derive its name from the ancient city of Colchis in Asia Minor, the drug is first mentioned in the Ebers papyrus of around 1500BC.

So, gout is obviously as old as civilisation. Indeed, there is a strong argument that it is a disease of civilisation. Dr Tom Scott, former consultant rheumatologist at London's Charing Cross Hospital, has said: 'There are plenty of underweight sufferers who never touch a drop, but there is a link between gout and the good life. Gout sufferers tend to be heavier and to eat and drink more than their peers, and both alcohol and a high-calorie diet raise the level of uric acid.' This is only half-way comforting. My brother John is a bricklayer, and he scarcely lives the high life, but he gets gout too. Like many others - and there are perhaps 200,000 sufferers, predominantly men, in Britain - we appear to have inherited a tendency to gout.

We have some illustrious predecessors. George IV, Queen Anne, William Pitt and Benjamin Franklin suffered, as famously did Dr Johnson who wrote to a physician in Plymouth in 1773: 'By representing the gout as an antagonist to the palsy, you have said enough to make it welcome.' His credulity was understandable given the state of medical knowledge at the time, but it sits ill with the other attribute of goutists: we are brainy.

A number of studies have revealed higher-than-average IQs among sufferers. Dr Scott again: 'Studies show that gout sufferers are not average people. They tend either to have been top of their class or bottom - because they were too clever to bother to do any work. The nature of the association is not clear. It may be that clever people become successful, and successful people often eat and drink too much.'

But such considerations do not make walking any easier with my ankle in its present state - six weeks on from New Years' Day. Normally, my attacks are short-lived and respond to drugs. This is different. I am becoming accustomed to the gibes of colleagues at Westminster. What I cannot get used to is the behaviour inhibition factor. There are a thousand and one things you cannot do.

If you've got gout, you can't do anything suddenly. You can't turn on your heel. You can't step out of someone's way - an action performed without thinking dozens of times a day on the Underground or in busy streets. You can't sit on the front seat on the bus downstairs because there isn't room to stretch out your leg. You learn to avoid stairs, or steps, and to look out for unexpected dips in the pavement. The main thing is to avoid making the pain worse. You begin to understand what it is like to be disabled.

Three capsules of Indomethacin a day proved insufficient to disperse the uric acid crystals. For a trial three-day period, my GP doubled the dose, and briefly I thought salvation was at hand, three weeks into the attack. I was able to walk, albeit stiffly and still in some pain. The respite proved illusory. Despite the double dose, both swelling and pain returned. Back at the surgery, practically in despair, and feeling like the most pathetic, wheedling sponger on the NHS, I begged my GP to 'do something'.

He asked me if I was in Bupa, which would get me swifter access to an arthritis specialist. Negative. Old fashioned Labour man. Never been interested. Hmmm. I could have forgiven him for saying, as a stern old nurse at the Times, asking if I had private medical facilities, once did: 'You haven't got a leg problem. You've got an attitude problem. Good morning.' But he didn't. He prescribed Colchicine, the modern version of colchicum. The active principle of autumn crocus was first isolated in 1820, about the time William Pitt was nursing his bandaged foot in Downing Street. For modern-day crocus eaters, the drug comes in tiny white pills, perhaps only a tenth of the size of the yellow bombers that were once my sovereign remedy. Take two immediately, and then one every two or three hours. Oh, and watch out for diarrhoea. If you get that, stop taking the tablets immediately. It is no fun getting the runs when you can hardly walk, as I discovered. So it was back to a double dose of Indomethacin, and, hallelujah] the swelling is gradually going down. The pain is taking longer. I am developing a limp.

Of course, medical science will be able to cope once this attack has been defeated. My GP has prescribed Allopurinol, the wonder-drug that will ward off further attacks if taken once a day. My colleague and fellow sufferer, the columnist Alan Watkins, is fulsome in his praise of Allopurinol. The drug acts against 'purines', proteins that exist to some degree in all foods and are actually necessary in the body to help replace cell tissue lost through normal wear and tear. But the breakdown of purines creates uric acid, the immediate cause of gout. An excess of purines equals excess uric acid. Mr Watkins has been chiding me for years to follow his example, but until now I have resisted, being reluctant to become dependent on medication. But if it's dependence or not being able to walk, dependence it will have to be.

Unhappily, there is also the question of lifestyle. I have been known to take a drink, and in the trade union movement and Westminster, the vineyard in which I chose to labour, this has been no small professional advantage. I recall being asked at an interview by Michael Cudlipp, Home Editor of the Times, if I drank. My answer, 'as much as the job demands', was warmly received.

But it is useless to pretend that alcohol plays absolutely no part in the onset of gout attacks - though that has never prevented me from loudly proclaiming the contrary in the past. So this is something in the nature of a disavowal. Booze causes gout. Dr Terry Gibson, consultant at Guy's rheumatology department, found in a study of 'lager gouts' in 1989 that heavy drinkers have a significantly higher intake of purines. He recorded 'a clear association' between drinking alcohol - especially beer - and gout. There is worse (there always is, don't you find?). The Arthritis and Rheumatism Council says that though gout is treatable with a variety of drugs, there is an increasing number of men whose gout is not responding to treatment because of their inability to cut down on beer. Am I one of those men?

It is a daunting prospect. I love my ale, but it is not my friend. What is the good of taking Allopurinol for the rest of my life, when it is only masking the real cause of the problem? These sombre thoughts bubble up naturally because my GP also told me to go on the waggon for the duration of crocus- eating. As the joke goes, the waggon has hitherto been going too fast when it passed by. But it slowed down the other day to let off a colleague on a Scottish newspaper (what else?), and I have managed to scramble aboard. Hello, virtual reality.

What is missing in the saga, it seems to me, is the comradely spirit. There is no hi-falutin' sufferers' club where us goutists can get together and yarn about ankles and big toes. Even sufferers of 'yuppie flu', which has not yet been satisfactorily proven to exist, have a mutual help group. Gouties have nothing, though the man at the Arthritis and Rheumatism Council giggled that something called the Salmon and Trout Club (Cockney rhyming slang, geddit?) had once been mooted.

The trouble is, as my fellow sufferer, magazine publisher Ross Davies, says is that people are too ashamed to admit they have gout. 'Quite simply, it is not a fashionable ailment. People keep quiet about it, because they just get laughed at.' Well, that is going to stop here and now. I am founding GoutRage] which will expose my fellow sufferers to the steady gaze of public attention - only, of course to improve public understanding of this potentially devastating disease. Step forward Michael Heseltine, who, close aides assure me, suffers from gout; come in, Nicholas Coleridge of Conde Nast. And admit it, author / playwright Nigel Williams] Together, we might even stop the man at the BMA sniggering.

(Photographs omitted)

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