The DT, Today, has an intersting (to me anyway), article about Gout, and much about other symptoms hidden behind it.
Sorry about how big it is:-
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"Have you ever considered you may have gout?” said the consultant.
At 51, as a fairly fit man with a largely vegetarian diet who only enjoys the odd drink, the answer was no. But the doctor was not kidding.
A little history. Last November, I had written a piece for this newspaper about the many ailments that 50-somethings like me were prone to suffering and listed all mine, from a bad back to aching hips, from a sore heel to a sod of a big toe. Soon after it was published, I received a message, via Twitter, from John Hardy, who told me that he thought he knew why I was suffering so much, especially as I was still comparatively young, and invited me for an appointment at his clinic in London.
In December I went to the Chelsea Outpatient Clinic to meet him. That appointment might have just changed my life.
Over the course of nearly two hours, Hardy delved deep into my – and my family’s – medical history, examining me and the countless X-rays and MRI scans I’ve had over recent years. He was especially intrigued as to why my previous three consultants had now subjected my right knee to five operations, the last three of which, he says, were largely unnecessary.
It transpired that all the many aches and pains I had been experiencing were, in all probability, down to an excess of uric acid in my body, or hyperuricemia, and that left me exposed to attacks of gout.
Gout is a type of inflammatory arthritis, the result of having too much uric acid in your body. It’s one of the oldest known diseases known to mankind, with a history dating back to 2,500 BC when the Egyptians first identified it.
Ordinarily, the kidneys work to expel uric acid but when they can’t, the rising levels will eventually lead to deposits of sodium urate crystals forming in and around your joints. It’s these needle-like crystals that rub against your joints causing pain, swelling and often severe discomfort.
Typically, gout sufferers will notice a stiffness and limited movement in their big toe as the first red flag (I know I did). It’s one of the telltale signs that your uric acid levels are too high. “The reason gout presents in the big toe so much is because we spend our lives stubbing it into doors and table legs or kicking things. It’s always getting traumatised and that makes it susceptible to gout,” explains Hardy.
But hyperuricemia can affect any joint, especially those that have been injured previously. In my case, I have experienced problems with my knee, my back and my hips in the past, and all of them have been giving me untold grief in the last year.
“It’s long been suspected that when uric acid reaches the upper levels of normal and starts to precipitate, it heads for those joints that are vulnerable,” adds Hardy.
Around one in 200 people in England and Wales has gout, rising to one in 40 in the over-75s. Statistically, men are more likely to suffer from it and they’re also more likely to get it earlier in their lives, between the ages of 30 and 50. The female hormone oestrogen helps the body to expel uric acid, so women can suffer with gout post-menopause.
Though gout can be triggered by a range of factors, including obesity, family history and advancing age, it has typically been associated with rich, meat-heavy diets and/or too much alcohol (especially beer and fortified wines) to wash it all down. The problem lies in the purines. While all plants and meats contain purines, some, like organ meats, red meat and shellfish, contain significantly more than others and if your body can’t process and filter them normally, it creates excess uric acid.
The first line of attack in terms of treatment is changing your diet to reduce the purines. Patients may also be given non-steroidal anti-inflammatories such as naproxen to manage the pain. Typically, more advanced sufferers might then be prescribed allopurinol or febuxostat, both of which have proven extremely effective in fighting gout.
So why did gout pick me? I suspect that my case is hereditary. Not only have I not eaten any meat for over 25 years but I don’t eat a lot of fish either and while I enjoy a drink it’s not like I’m downing a bottle of port every evening.
My late mother suffered enormously with arthritis in her hands and feet while my brother, two years older than me, has also experienced problems with his lower legs. My mum was never diagnosed with gout but, looking back, it’s hard to see how it could have been anything else.
Hardy warns that many cases of gout go undiagnosed, leading to unnecessary treatments, procedures and pain. One problem, he says, is the decision made in the early 1980s to stop testing uric acid levels in standard urea and electrolytes (U&E) blood tests. While I have had many blood tests in recent years ahead of my knee operations, I’ve never had my uric acid levels tested until Hardy got me to request one. If I’d had one earlier, there’s every chance I wouldn’t have needed quite so many operations on my knee.
Hardy has encountered many patients who, after a joint replacement, have complained that their pain hasn’t gone away and yet they’ve had all the tests – except those for gout. While I didn’t have a knee replacement, my arthroscopies always followed the same frustrating and painful post-operative pattern, with the very same swelling and pain always returning to my knee within a week of leaving hospital.
“We should be doing everything we can to manage gout by spotting it early, as prevention is ten times more cost effective than cure,” adds Hardy. “If we reintroduced the serum uric acid level element to blood tests we could spot those people who are more likely to run into joint problems, kidney problems and so on. It would not only save a huge amount of money and reduce the number of costly joint replacement operations but it would increase the profile of gout in general practice where it’s all too often missed or dismissed as arthritis.”
My blood test showed that I did have uric acid levels at the very top of end of normal, meaning I could be prone to a gout attack should I have a purine-heavy diet for a while.
I was advised to change what I eat accordingly and have just come to the end of a six-week low-purine trial. Prawns, tuna and anchovies have all gone, as has chocolate and any fruit juices and soft drinks containing fructose. And, quite remarkably, no beer has touched my lips in 2021. I have enjoyed the occasional glass of red wine but it’s the brewer’s yeast in beer that makes it the gout sufferer’s nemesis.
The result? Within a week of cutting down on the purines, I noticed more flexibility than I had in a year or maybe more. My sleep, meanwhile, is sound and, for the most part, pain-free and I don’t really ache in the morning. I still have occasional knee pain but nowhere near what it used to be
My recent follow-up blood test revealed that my uric acid levels have dropped markedly. The good news is I now know what I have to do to in order to minimise my chances of a gout attack in the future and preserve my joints into old age.
The bad news is that means no more beer.
Visit johnhardy.co.uk for more information. Follow him on Twitter at @orthoandtrauma
Read more: Allison Pearson: Thanks for welcoming me into the Gout Club – at least I know I’m not alone"
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Again, sorry about the length of the article. Hope it is useful.
We could do with more of that in the world!
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That’s probably half the problem…
