“It was the worst pain ever — I thought I had broken it. I couldn’t even walk, but I hadn’t done anything to injure it,” recalls Harry, who was just 27 at the time. 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 being old – not men in their 20s,” admits Harry, who lives in South East London and works for a plumbing supply company. New figures show the so-called ‘disease of kings’ is on the rise, with hospital admissions for gout on the rise. It is believed that this increase is largely a result of lack of exercise and poor diet during successive lockdowns. The number of cases rose by 20 per cent in three years, with 234,000 patients admitted to hospital with gout in 2021-22, according to figures published last month by the NHS. New figures show the so-called ‘disease of kings’ is on the rise, with hospital admissions for gout on the rise. It is believed that this increase is largely a 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 painful condition, according to the charity Arthritis UK. But experts say that while lifestyle can trigger a flare-up, genetics play a bigger role in who gets gout in the first place. Harry’s father also had gout, for example. And it is feared that outdated perceptions of gout as both self-inflicted and transient are preventing thousands of people from taking medication to prevent attacks.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 Gout Society UK, who believes it is still seen as a Victorian condition, caused by too much drinking and eating. 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 appropriate treatment. The importance of this was highlighted by research published last month in the Journal of the American Medical Association, which found that those with gout were more likely to have a heart attack or stroke in the four months after a flare-up than people without gout. arthritis. Scientists from Nottingham and Keele Universities, who followed 62,000 gout patients in the UK, said this is because the inflammation caused by the condition not only affects the joints but also other parts of the body, including the arteries around the heart . Gout – the most common form of inflammatory arthritis in the UK – is caused by a build-up in the blood and tissues of uric acid, which is 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 painful condition, according to the charity Arthritis UK. But experts say that while lifestyle can trigger a flare-up, genetics play a bigger role in who gets gout in the first place [File photo] Gout occurs when the kidneys cannot properly excrete this uric acid. Uric acid crystals then form inside the joints and under the skin, leading to severe pain. Uric acid crystals in the kidneys can also lead to kidney stones and severe decline in kidney function. Dr. Dickson says millions of people have excess uric acid in the blood but don’t have gout because they don’t have the genetic susceptibility. But those who are genetically susceptible may go on to develop full-blown gout if an environmental factor — such as a virus — causes the immune system to recognize the crystals as foreign bodies, setting off an inflammatory response. Once primed, the immune system continues to attack the body, which is why long-term tail reduction therapy is required. Attacks are usually treated with the anti-inflammatory drug colchicine or pain relievers including ibuprofen. The prophylactic drugs allopurinol and febuxostat (which lower uric acid levels) are recommended by the National Institute for Health and Care Excellence (NICE) for “multiple or worrying” flares. NICE also recommends that these drugs, which cost just 28p per tablet, should be discussed with all gout patients, as most will suffer future attacks without them. However, a report in the journal Lancet Regional Health — Europe in May found that only a minority of patients in the UK are given preventive medication 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, flare-ups tend to become more frequent over time and can develop into chronic arthritis which never completely subsides.
Rude health
Men who regularly indulge in their sweet tooth could be harming their fertility, reports the journal Reproductive Sciences. A study of 300 men showed that sperm concentration was 15 percent lower in those who ate the most foods containing added sugar – including cakes and ice cream – compared to those who ate the least. It is believed that high sugar content can damage DNA, affecting sperm motility and quality.
“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 gout is for many patients a long-term chronic condition that requires careful management, not just an episode that can be managed by switching to a low-purine diet. Luckily for Harry Tyndall, his doctor immediately prescribed allopurinol after his visit to A&E in 2016. It is thought that although 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) caused a full-blown attack. Allopurinol helped relieve 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 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 watch my diet, there’s no need to fear another flare-up,” says Harry. “But it makes me angry that people think of gout as an ‘old man’s’ condition or something that greedy people get. “Gout can affect anyone and we need to be more aware of it.” ukgoutsociety.org
Under the microscope
England’s most capped footballer Peter Shilton, 73, takes our health quiz 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. As soon as I recover, I will 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] it has changed my diet quite a bit so I eat more fruits and vegetables now. I love carrots, brussels sprouts, fresh kale and green beans. Do you ever diet? Never. I only weigh about 7kg more than when I played. I’m 6ft 1in and currently around 17st. I have plenty of muscle on me. No malice? LUCKY GAMES. I don’t know if seeing my dad have a big horse win when I was little triggered something, but I always liked it and it gave me a big response. The real escalation came when online betting arrived, which allowed me to sit at my computer and bet for hours. Things only started to change when I met Steph in 2012. It wasn’t easy to stop. England’s most capped footballer Peter Shilton, 73, takes our health quiz Are there any family illnesses? My dad died of a heart attack, aged 93, in 2015. My mum got Alzheimer’s and died two years later. I take my big hands from her. Worst injury? I opened my eye once at Wembley when I collided with De Walker while playing against Brazil in March 1990. It went to the bone and was the most painful experience of my life. My hip that needed to be replaced was the biggest problem with me physically. Pop any pills? 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 fit, but I’d rather go work out. Cope with pain well? I’m pretty well, but the last few months before my hip surgery I was in horrible 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 covered up the impact of the 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 think that I might lose Steph if I didn’t stop. What keeps you up at night? I generally sleep well. People ask me if I have sleepless nights about Maradona’s ‘hand of God’ goal at the 1986 World Cup in Mexico, but I don’t. If he hadn’t cheated, I would have had the ball. Any phobias? I really hate snakes. Peter is supporting the 25th anniversary of GamCare (gamcare.org.uk). Interview by Nick McGrath
