Suddenly, gout increases, why are so few patients getting the treatment they need?

The new figures suggest that the so-called

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

“It was the worst pain ever – I thought I’d broken it. I couldn’t even walk, but I hadn’t done anything to hurt it,” recalls Harry, then 27.

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 living too well and old people, not twenty-somethings,” admits Harry, who lives in south-east London and works for a delivery company in plumbing

New figures suggest the so-called ‘disease of kings’ is on the rise, with hospital admissions plummeting. This increase is believed to be largely the result of lack of exercise and poor diet during successive confinements.

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

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

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

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And it is feared that outdated perceptions of gout as self-inflicted and transient are preventing thousands of people from receiving drugs to prevent attacks.

“There is a lack of awareness that it is inherently a genetic disease,” says Dr Alastair Dickson, GP and trustee of the UK Gout Society, who believes it is still seen as a Victorian disease, caused by too much drinking and food.

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 the right 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 following a outbreak than people without gout.

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

Gout, the most common form of inflammatory arthritis in the UK, is caused by a build-up 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 dying disease, according to the charity Arthritis UK.  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 dying disease, according to the charity Arthritis UK. 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 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 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, launching an inflammatory response.

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

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

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

However, a report published in May in the journal Lancet Regional Health — Europe found that only a minority of patients in the UK receive preventive medicine 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, outbreaks tend to become more frequent over time and can become in a chronic arthritis that never settles completely.

rude hello

Men who regularly consume their sweets could be harming their fertility, reports the journal Reproductive Sciences.

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

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

“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 do not appreciate that, far from being a one-off episode that can be tackled by switching to a low-purine diet, gout is for many patients a chronic, long-term condition that requires careful management .

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

It is believed that while 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 16st) triggered a full-blown attack.

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

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

Now, aged 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-up,” 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 need to be more aware of it.”

ukgoutsociety.org

under the microscope

England’s most capped men’s footballer Peter Shilton, 73, takes our health test

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 was doing daily 20-minute runs. When I’m back I’ll start again.

Do you 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 i eat more fruit and veg now. I love carrots, brussels sprouts, fresh cabbage and green beans.

Have you ever been on a diet?

never I weigh only about 7 pounds more than when I was playing. I’m 6ft 1in and right now I’m about 17 years old. I have some muscle on top.

Any vice?

Games of chance I don’t know if watching my dad win big on horses when I was a kid triggered something, but I’ve always liked it and it gave me a kick. The real escalation came when online betting arrived, allowing me to sit at my computer and play for hours. Things only started to change when I met Steph in 2012. It wasn’t easy to stop.

England's most capped men's footballer Peter Shilton, 73, takes our health test

England’s most capped men’s footballer Peter Shilton, 73, takes our health test

Any family illness?

My father died of a heart attack, aged 93, in 2015. My mother suffered from Alzheimer’s and died two years later. I take my big hands off her.

The worst injury?

I opened my eyes once at Wembley when I collided with Des Walker while playing against Brazil in March 1990. It was to the bone and the most painful experience of my life. The need to replace my hip has been the most physically wrong thing for me.

Take a pill?

I take multivitamins every day for bone and muscle strength.

Have you ever had plastic surgery?

No way. Obviously, I have a younger wife, so I have to keep my fitness up, but I’d rather go training.

Dealing well with pain?

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

Have you 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 play on the Internet all day and not finish until 3 in the morning. I slowly began to understand that I might lose Steph if I didn’t stop.

What keeps you up at night?

I’m generally a good sleeper. People ask me if I have sleepless nights over Maradona’s ‘hand of God’ goal at the 1986 World Cup in Mexico, but no. If he hadn’t cheated, he would have caught 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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