’Rich man’s disease’ can affect anyone if you don’t look after yourself

GOUT is known as “the rich man’s disease” and even “the disease of kings”.

Sounds good, doesn’t it? Indeed, in certain eras, it was viewed as a socially desirable ailment such was its association with rich and lavish diets and lifestyles.

An extract from the London Times in 1900 states: “The common cold is well named but the gout seems instantly to raise the patient’s social status.”

Presumably those coveting this condition had never actually suffered an episode or else they might have been inclined to change their minds — many patients with gout describe it as one of the worst pains imaginable.

Any joint affected can be excruciatingly painful even when the victim’s bed clothes just brush over it.

Gout is, at its core, a form of arthritis. That is to say it is an inflammation of a joint.

A bout of it results in a painful, swollen, sometimes warm and very tender, joint.

It can come on quite suddenly, often waking you up in the early hours of the morning, and it generally lasts for about five to seven days before settling down again.

The most common focus is the big toe. In fact, the ancient Greek name for gout was podagra, which translates as “foot grabber”.

The 1799 print by famous caricaturist James Gillray very much plays on this.

Of course, gout strikes elsewhere as well, typically the knees, ankles and fingers and more rarely the eyes, nose, spine and skin.

It is caused when spiky crystals of uric acid develop in a joint, so if you have high levels of uric acid in your blood, a term known as hyperuricemia, you are more prone to developing gout. Uric acid is a breakdown product of a protein called purine which is present in higher levels in certain foods, ones historically accessible only to the rich and famous such as Henry VIII who was a well-known sufferer.

These include seafood, in particular oily fish, caviar, crabs and shellfish, alcohol (beer more so than wine), offal such as liver and kidney and other yeasty foods including Bovril, gravy and Marmite. Red meats and legumes also carry a moderately high level of purines.

If such a purine-rich diet is followed, one might be up to five times more likely to develop gout than the average person.

That is not to say, of course, that all purine-rich foods are to be avoided completely since some of them have other valuable nutritional benefits.

Why is the big toe affected more than elsewhere? The answer is likely multifactorial but, in short, uric acid tends to crystalize at lower temperatures or in areas where there has been some blunt force.

Thus the position of the big toe along with its relatively rougher life compared with other parts of the body makes it relatively more vulnerable.

Gout is much more prevalent in men, although women become somewhat more prone to it post-menopause than they are pre-menopause.

These days, it is far less discriminatory, in keeping with a spread of western (often purine-rich) diets and this has resulted in not only a greater prevalence worldwide but a lack of social boundary.

As far back as 1964, Punch magazine stated: “In keeping with the spirit of more democratic times, gout is becoming less upper-class and is now open to all… it is ridiculous that a man should be barred from enjoying gout because he went to the wrong school.”

Besides diet, gout is also quite likely to have a hereditary element so, apart from this unavoidable aspect, the best approach to preventing it is by adopting a healthy, balanced, low-purine diet.

Those who do not do so run the risk of recurrent episodes which can lead to more permanent joint damage in the future. In severe cases, sufferers may even start to develop deposits of uric acid crystals under the skin, resulting in lumps known as “tophi” (named after the Latin for stone) cropping up under the skin.

These can be seen over the joints affected or over other areas of skin such as the earlobe. Without intervention, it should be noted that those with gout are at twice the risk of developing cardiovascular disease such as heart attacks or strokes.

So if you get a bit of gout that should be a wake-up call to start looking after yourself better.

An enhanced risk of diabetes and kidney disease is also something to bear in mind.

This means getting your cholesterol checked, monitoring your blood pressure, getting more exercise, eating more healthily and cutting down on alcohol and smoking.

Losing weight alone will cut your uric acid levels but don’t go on any crash diets; this will most likely worsen the gout rather than help it. Instead, it is far better to alter things gradually and more sustainably.

For an acute attack of gout, the mainstay of treatment and pain relief is the use of a short course of a non-steroidal anti-inflammatory such as ibuprofen. If this is not cutting it, you might want to try a stronger one such as naproxen, which your GP will be able to prescribe.

Remember these can irritate your stomach so you might be prescribed another tablet to protect it (omeprazole is the most common).

Another medication used much more specifically for gout is colchicine. This is derived from the autumn crocus and was used as a purgative by the ancient Greeks.

As such, one slightly inconvenient side effect of this medication can be a nasty case of diarrhoea but it works well to help the pain at least.

On occasion, gout can be precipitated by certain medications such as a subtype of water tablets (diuretics) known as thiazide diuretics.

Other medications can be at fault as well so your GP may suggest withholding these or even changing them if gout is becoming a problem.

For severe cases, an injection of steroid into the affected joint could provide relief, as could an oral course of steroid.

Sometimes, if the diagnosis is not 100 per cent clear, physicians may opt to take a sample of fluid from the affected joint (there is another similar condition known as pseudogout which is down to calcium pyrophosphate crystals) but in general the diagnosis is clinical, backed up by blood tests to check urate levels in the blood.

If a patient continues to experience recurrent episodes, attention turns once more to prevention.

Some studies have found that vitamin C can reduce uric acid levels so there is probably no harm in trying some over-the-counter supplements.

It may be that your doctor tries you on a medication known as allopurinol. This was discovered and developed alongside various other medications in the Eighties, earning its creators the Nobel Prize. It works by suppressing the uric acid in the blood and therefore reducing the risk of developing crystals.

It should be started once acute episodes of gout have died down but should then be taken once daily thereafter, not to be stopped even if you experience a further episode.

Of course, none of this should detract from the advice to maintain that healthy diet and lifestyle which, aside from low-purine foods and plenty of exercise, should also include adequate hydration (about eight glasses of water a day) and sticking to no more than the recommended limit of 14 units of alcohol over the course of a week.