Gout is on the rise, yet sufferers still face judgment
Gout, the most common form of inflammatory arthritis, affects about 1.6 million people in the UK, and its global incidence is projected to climb by 2050. Specialists say stigma deters people from seeking treatment, even though the condition is treatable.
Gout, caused by raised levels of uric acid in the blood, is the most common form of inflammatory arthritis, and the number of people living with it is growing. According to The Guardian, it affects 2%–4% of people in the UK, Europe and the US, or about 1.6 million people in the UK. Researchers and doctors stress that its image as a disease of the well-off reduces understanding and delays treatment.
How the condition develops
Uric acid is produced when the body breaks down purines, found in cells and certain foods. If levels stay high for long periods, sharp crystals can form in the joints, causing inflammation, redness and severe pain. Hardened lumps of crystals, called tophi, can later form under the skin. Almost everyone with gout has raised urate levels, but most people with raised levels do not develop gout, says consultant rheumatologist Prof Edward Roddy.
The first attack usually strikes the big toe and can begin overnight. Untreated, gout can spread to other joints in the foot and ankle, the knee, hands, wrists and elbows. Worldwide, about three times as many men as women are affected. Global incidence is predicted to rise by 70% between 2020 and 2050, largely due to population growth and ageing. There are reports that sufferers are becoming younger.
Stigma and treatment
The first flare often subsides on its own, so younger people may not seek help. Brett McAllister-Byrne, a 40-year-old urban planner, had his first attack in his early 30s and only went to a doctor in the past two or three years. He says others do not take the condition seriously and imply it is self-inflicted, although he is mostly vegetarian and does not drink regularly; he believes it is inherited.
Guidelines from the UK's National Institute for Health and Care Excellence (NICE) say patients with persistent flare-ups should receive urate-lowering drugs such as allopurinol until a target of 360 micromoles per litre is reached. In practice, doses are not always tested to confirm they work. In a 2018 study, members of the public were more likely to link the condition to ageing and see it as more serious when it was called “urate crystal arthritis” rather than gout.
