As a study reveals that the UK has the highest rate of gout in Europe – with the North-East one of the ‘hot-spots’ – Abi Jackson reports on this particularly painful form of inflammatory arthritis

HISTORICALLY seen as an illness that punishes over-indulgers with lavish lifestyles, guilty of drinking too much red wine and gorging on a meat-rich diet, gout has been treated as a joke.

Sufferers are often stereotyped and their affliction – often a sore and swollen big toe – mocked.

But, with people living longer, gout is on the rise, and it’s not just older people who are affected.

It is the most common type of inflammatory arthritis, affecting 1.4 per cent of UK adults, and for anybody who’s experienced it, it’s no laughing matter, widely recognised as one of the most excruciating forms of joint pain.

So what is gout, what causes it and who gets it?

MAIN SYMPTOMS

TYPICALLY, a rapid onset of intense pain and swelling in the affected joint are the main symptoms, but as Professor Alan Silman, Arthritis Research UK’s medical director, points out, gout can be acute or chronic.

“With acute gout, you get a sudden attack of what looks like arthritis, normally affecting just one joint. Often it’s the big toe, though we’re not sure why,” he says. “But it could be an ankle, a wrist or an elbow. That joint, over a very short period of time – a few hours, for instance – becomes very swollen, very red and extremely tender.”

Skin in the affected area may also appear shiny.

Acute attacks will normally settle quite quickly, returning to normal after a week to ten days.

Chronic gout, Prof Silman says, may occur with more of a gradual onset, and might look like osteoarthritis, but only affecting one joint.

Some people with high uric acid levels can experience chalky-white deposits coming out in unpleasant- looking lumps, which can occur in any part of the body. “It could come out of the ear, often on the back of the hands,” says Prof Silman. “If you have this, you should go and see your GP.”

THE OUCH FACTOR

GOUT Is often known as one of the most painful types of inflammatory arthritis. “There aren’t many conditions that give you such a tenderness of the joint,” says Prof Silman.

“Because of the pain, chances are, somebody experiencing an acute attack will be unable to put on a sock, let alone attempt to walk and carry on with their day as normal.”

COMMON CAUSES

URIC acid, a compound produced by the body’s cells when breaking down food, is the key component.

It is usually flushed out of the body, but if excess levels build up in the blood, sodium urate crystals can form, triggering gout.

The link with diet and over-indulging has come about because red meat, some seafood and shellfish, and beer, have high quantities of purine, which is responsible for uric acid production in the body.

But Prof Silman says: “Gout has many background causes. There are some relatively minor genetic factors, which if you’re unlucky enough to have them and you have a lifestyle containing lots of red meat, red wine and very rich foods, it can put you at risk. Gout can also appear as a side-effect of some drugs and diseases, like kidney disease and some cancers. There are also rare occasions where people are born with chemical imbalances that mean they can’t break down uric acid normally.”

About four times as many men than women get gout, but the gap narrows as you get older. For men particularly, it can strike at any age.

TREATMENT

GOUT can sometimes be confused with osteoarthritis, but it’s easy to tell the two apart.

“To confirm the diagnosis, you might take some fluid from the joint to see whether there are crystals in it,” says Prof Silman. “There are also specific patterns on X-rays, and if you did a blood test, you would have raised levels of uric acid.”

For an acute attack, the first step is to take antiinflammatories.

Ice-packs can help, and steroids might be prescribed. But it is important to identify the root cause to prevent it coming back.

“Adapting your lifestyle may also be necessary,”

says Prof Silman. “Reducing your intake of alcohol, red meat and shellfish, for instance, and losing weight if you are overweight.” Drink plenty of water and increase your intake of vitamin C-rich fruit and veg to lower uric acid levels naturally.

Sufferers may need longer-term medication.

“There’s a drug called allopurinol. It’s a very safe, effective drug to reduce uric acid and stop you having attacks,” says Prof Silman.