Gout is synonymous with the Tudor king Henry VIII; in fact, it was dubbed the ‘disease of kings’ because of its association with high living, albeit queens suffered, too. Queen Anne, who reigned from 1702 until her death in 1714, experienced bouts of gout, as depicted in the film The Favourite with Olivia Colman.
We’ll come onto the link between gout and high living shortly, but unless you suffer from gout – a reported one in 40 in the UK alone – you might be unaware what it is, so an explainer.
What is gout?
“Gout is a type of arthritis that causes sudden and extremely painful inflammatory attacks in the joints, most commonly the big toe, ankles and knees but any other joint, too,” says Lynsey Conway of the UK Gout Society, a charity that provides information to people living with gout. “It’s the most common form of inflammatory arthritis worldwide.”
What causes gout?
It's caused by excess uric acid in the bloodstream, the technical term of which is ‘hyperuricaemia’. Uric acid is a waste product created when your body breaks down chemicals called ‘purines’ in your food and drink. These are found in the cells of all living things, including humans, plants and animals, so there’s no way to eliminate them from your diet.
“Gout sufferers have high levels of uric acid because it’s not efficiently removed by the kidneys and washed out in the urine,” says Conway. “This overload results in painful, needle-like urate crystals forming around the joints and under the skin – for example, on the ear – as small white pimples (known as tophi). Occasionally, stones may form in the kidneys, too.”
Who is at risk of developing gout?
Gout’s association with the rather gluttonous Henry VIII is that your chances of getting gout crank up if you’re obese, and eat excessive red meat, offal and seafood, all washed down with beer or spirits. Fruit juices and sugary drinks aren’t great, either.
High blood pressure, diabetes, kidney problems and even some medications, such as diuretics, aspirin, beta-blockers, niacin and some chemotherapy medicines, also put you at greater risk. But the most dangerous warning signs derive from your genealogy.
Is gout genetic?
“Despite reports to the contrary, gout is more genetic driven than diet driven,” says Conway. “Most studies suggest hereditability of gout between 45% and 73%, and about 20% of people with gout will have family members with the condition. Your risk is even greater if you have a first-degree relative (a parent or sibling) with the condition.”
What the genetic link is remains unclear, though a recent study in the journal Nature Genetics uncovered several genes in pathways that might be responsible for the progression of hyperuricaemia to gout. The net is closing in, albeit the study detected a significant 377 different loci of genes linked to the disease. So, work to be done.
Which will be work appreciated by men more than women, certainly when it comes to numbers as gout affects men five times more than women, while it’s rare in children. In men, it can occur any time after puberty, whereas in women it’s uncommon before the menopause.
Why the gender imbalance seems to be down to the hormone oestrogen, which is much higher in women than men. Oestrogen helps the removal of uric acid by the kidneys, which is why gout’s more common in women who’ve gone through the menopause.
Worryingly, the global prevalence of gout is on the up, increasing by 22.5% between 1990 and 2020. While many point the finger of blame at ultra-processed foods, which are lacking in nutritional benefits, Conway suggests that’s only part of the problem.
“Yes, the growing obesity epidemic is an issue,” she says. “But the reason for the rise is multifactorial and also includes an ageing population (as you get older, your kidneys become less effective and so it’s more difficult to filter out the uric acid through your wee) and the growing use of certain medications [mentioned above].”
How to treat gout
“Too much emphasis is placed on diet and lifestyle as the main cause of gout,” Conway adds. “We believe this leads to stigma and ‘gout-shaming’. While maintaining a healthy diet and lifestyle is important, as stated in the latest NICE [National Institute for Health and Care Excellence] guidelines on managing gout, ‘People [with gout] should know that diet and lifestyle changes are not enough, and that long-term urate-lowering therapy (ULT) is usually needed for this lifelong condition’. Unfortunately, we know that only a third to a half of patients with gout aren’t prescribed this potentially ‘curative’ treatment, while fewer than half of patients adhere to treatment.”
This includes urate-lowering medication such as allopurinol, which helps to prevent the painful crystal formation (tophi) around the joints.
“Before then, while suffering from an attack, see your doctor, who’ll treat the pain and inflammation of a gout attack as soon as possible using painkillers such as non-steroidal anti-inflammatory drugs (NSAIDs), colchicine or steroids,” says Conway. “Ideally, keep off the joint and ice it regularly, too.”
Though genetics plays a significant role, Conway also suggests that once an attack of gout has passed, if overweight you may be advised to lose weight. That’s in addition to cutting down on Henry VIII’s culinary go-tos cited above, including red meat and alcohol.
All in all, there are proven choices to not only prevent gout but lead to a healthier and potentially happier life. Tick those off for starters. Unfortunately, your DNA might still lead to crystal pain. If it does, do what children have done for millennia and blame your parents.