Hospital cases of gout — known as the “disease of kings” — have almost tripled in England since 2010.
Experts said patients should demand drugs from their GPs to lower the risk of long-term complications. The Times understands that the National Institute for Health and Care Excellence (Nice) intends to develop guidelines on managing the disease, the second most common form of arthritis in the UK.
There were 65,387 recorded cases of gout in England’s hospitals in 2010-11. In 2017-18 there were 165,734 — an increase of 153 per cent.
The figures come as the disease makes a Hollywood appearance in The Favourite. Olivia Colman plays Queen Anne, who was confined to a wheelchair with gout.
Experts said the soaring rates were driven by an ageing population and the obesity epidemic, accompanied by “appalling” care for people who had received a diagnosis of the condition.
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Gout occurs when levels of uric acid in the blood rise above a critical level, and sodium urate crystals form in and around the joints. This can trigger a sudden painful episode of severe joint inflammation, described by many female sufferers as worse than childbirth, which then settles back to normal within a week. However, build-ups of crystals over years can damage joints.
It was once thought gout was caused by consuming too much food and drink with high levels of uric acid, such as red meat, shellfish and beer. However, more recent research suggests that genes plays a much greater role, governing how well the body can get rid of uric acid through the kidneys.
Michael Doherty, professor of rheumatology at the University of Nottingham and the clinical spokesman at Versus Arthritis, said: “Being overweight or obese increases production of urate, and may also elevate urate levels — overall increased weight is more important than individual dietary components.”
He said drugs to lower levels of urate in the blood, eventually dissolving the crystals around joints and preventing painful flare-ups, had been available for 50 years but were not being properly used. Only 40 per cent of patients have ever been prescribed the therapies, he said, and many of them were not on the right doses or not taking the drugs for the long term, which was necessary for them to be effective.
“The bottom line is that care of people with gout is worse than just suboptimal, it is appalling,” he said. “A lot of people in the population, and patients, don’t even know it is a type of arthritis. They think it is just something that comes and goes when you overindulge.
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“A lot of doctors share these misconceptions, even though they have gone to medical school.”
He said Nice guidelines explaining how to handle patients with gout, and what optimal levels of uric acid in the blood should be, “would change GP behaviour overnight”. Patients should not be afraid to go back to their GP and request treatment with drugs to reduce their uric acid levels and avoid flare-ups, he said.
People with gout are much more likely to develop further health conditions, including type 2 diabetes, high blood pressure and kidney disease. Versus Arthritis said 54 per cent of people with gout were expected to have at least one accompanying health problem within five years of diagnosis.
While gout featured in a recent Tatler magazine list of upper-class signifiers, Professor Doherty said it was no longer a disease of the rich. “It used to be that getting overweight only happened if you were rich,” he said. “It has reversed now. It is a poorer person’s disease because obesity goes with bad nutrition and impoverished socioeconomic status.”
Case study
Adrian Warr, 40, had always been aware he was at a higher risk of gout because his maternal grandfather had it.
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A communications consultant who has been in Hong Kong for more than five years, he thinks more people should know about the high genetic element of the condition. “My mother always warned us that because of her father suffering badly, there was a chance it would get passed down,” he said. “The first time I got diagnosed was when it got so painful I had to wake my now wife in the middle of the night to take me to A&E, nine or ten years ago. My toes were swelling up and I was in really bad pain. I pretty much knew what it was before I got into hospital.
“In the waiting room, I needed to keep my foot elevated, but there was nothing to elevate it on. My girlfriend sat on the floor for me to rest it on her.” He has tried to manage the disease through diet and lifestyle changes, such as controlling weight and alcohol intake and is now taking drugs to help.
He said that people should look up uric acid levels in food, rather than assuming they knew the worst offenders, with foods such as lentils high in purines, which are turned into uric acid. However, he added: “I make a joke of it being a disease of kings. Of all the things you could have, it’s not that bad in the grand scheme of things.”