Why you could develop gout – and what you can do to treat it

It’s incredibly painful but eminently avoidable – here’s how to prevent an attack

For centuries, gout has been a misunderstood disease associated with jolly, rotund (and usually male) bon viveurs who pay the price for all the wine, women and song by developing gigantic, painful swollen feet. When Henry VIII was diagnosed with gout, it is said to have become a fashionable disorder, referred to as ‘the disease of kings’. Rich Europeans aspired to develop the condition as a status symbol: evidence of a luxuriant and decadent lifestyle. As George Eliot wrote in Silas Marner: “The rich ate and drank freely, accepting gout and apoplexy as things that ran mysteriously in respectable families.” 
The truth is that anyone can develop gout: man or woman, rich or poor, young or old, drunken and greedy or sober and austere. Hollywood star Jared Leto admitted to developing gout after gaining 27 kilos for an acting role. Dick Cheney and ex-Liverpool footballer Harry Kewell are also reported to have suffered from attacks. 
Gout is an arthritic condition caused by an excess of uric acid in the blood which, if present for long enough, will form into tiny needle-like crystals that can inflame your joints and cause severe pain and swelling. 
While lifestyle factors can influence your likelihood of developing the condition, they are not as relevant as plain old bad genetic luck. “Gout is caused when the kidneys are unable to excrete uric acid from the body,” says George Nuki, Emeritus Professor of Rheumatology at the University of Edinburgh. “It is a metabolic issue, although your lifestyle can make it worse if you’re bingeing on food and drink that increases uric acid levels.”
It is estimated that between one and two people in every 100 in the UK are affected by gout (making it the most common form of inflammatory arthritis). Men over 30 are the most common sufferers, but post-menopausal women are also susceptible due to the lack of the protective effect of oestrogen.
And while gout is on the rise in the UK and beyond, the good news is that it is eminently treatable and, in most cases, completely curable. 
“I’m a firm believer that you shouldn’t ever have to endure more than one flare-up of gout in your life,” says Dr Michael Spira, medical director of The Smart Clinics in London and author of Goutbusters: How to Fight Gout and Win. “But identifying it and seeking proper treatment is essential.” Many sufferers are not doing so, it seems. According to a recent study in The Lancet, years living with a disability attributed to gout increased between 2010 and 2019. This seems to be due to a lack of proper treatment: only 35% of patients diagnosed with gout in the UK in 2020 were prescribed the urate-lowering medication that is proven to stave off the condition permanently.
“Most people will know they have gout when they suffer from severe pain and swelling in their foot,” says Nuki. “It is most commonly found in the big toe but it can manifest around any joint in the body, especially those towards the end of limbs such as ankles, knees and fingers. There is often a burning sensation on the joint and the skin around it can appear red and shiny.”
According to sufferers, the pain is immense and unmistakable. Many report that they can’t even stand the feeling of bedsheets on the affected area at night and have to sleep with their foot hanging out of the bed. “Some women have described the pain as on a par with childbirth,” says Spira.
Routine blood tests will usually identify excess levels of uric acid, which will alert doctors to the need for treatment. But most people won’t know they have gout until they suffer a sudden, painful flare-up.
“We would initially prescribe an non-steroidal anti-inflammatory drug (NSAID) such as naproxen to relieve the pain and reduce the swelling. These usually work very quickly,” says Spira. 
“If they don’t, we might prescribe a long-established medicine called colchicine that can also treat acute symptoms in the short term,” says Spira. 
For some, the condition might not return. “I would continue to monitor uric acid levels in the blood in the weeks that follow the initial attack to see if it is likely to reoccur,” says Spira. “Some people may need to go on a long-term drug that lowers uric acid levels, such as allopurinol.”
A recent study found that one in six sufferers of gout will experience another flare-up within 12 months. This can be prevented by taking daily doses of urate lowering therapy drugs, of which allopurinol the most common (it is available under several brand names including Zyloric and Uricto). 
“People don’t always choose to start taking allopurinol after their first attack,” says Nuki. “It might be a one-off. But if you are found to have a predisposition to excess uric acid in the blood, then it’s advisable to start taking it daily on an ongoing basis. Allopurinol can sometimes precipitate further attacks in the first few months of taking it, so your doctor would usually prescribe a small dose of colchicine or an NSAID for three to six months after starting treatment.”
Alongside this, lifestyle changes are necessary. The UK Gout Society advises cutting down on foods rich in purine (the substance that creates uric acid in the blood when broken down by the body). These include liver, anchovies, mackerel, dried beans and peas and yeast-rich drinks and foods, particularly beer. 
“Most people can eat a normal diet and don’t necessarily need to forgo these things completely,” says Nuki. “The real risk is in bingeing on purine-rich food and drink over short periods of time.”
Foods that are low in purine include milk, eggs, lettuce, tomatoes, green vegetables and peanut butter. “It’s generally a healthy diet that will help, with plenty of fruit and vegetables,” says Spira. “This will help reduce your weight. Obesity is a condition closely associated with gout.”
So, too, are hypertension and impaired kidney function, so gradual weight loss and regular exercise are advisable to anyone who has suffered from gout, says Nuki. “It is wise to avoid too much beer over a short period of time. Avoiding excessive habits will help. But it is wrong to think that gout is only related to lifestyle. Most people can excrete excess uric acid via their kidneys. People with gout cannot, so they will probably need additional treatment to cure the condition completely.”
Spira also advises cutting down on caffeine and staying hydrated. “Aside from gout, high levels of uric acid can also contribute to kidney stones, so it’s very important to drink plenty of water. I advise patients to make sure their urine is always a very light straw colour.”
If you find yourself in the grip of an agonising attack, the most important thing is to treat the affected joint with a great deal of tender loving care. The UK Gout Society suggests resting the joint in an elevated position. “For those who find that they cannot bear the weight of the bedclothes on the inflamed joint at night, an improvised ‘bed cage’ to hold the sheets away from the gouty joint can help… some people find an ice pack (or a packet of frozen vegetables covered by a tea towel to protect the skin) can also relieve pain to some extent.”
And while regular exercise is advisable once the flare-up has subsided, it is never, ever a good idea to try to jog on a gouty foot. “The pain would make it completely impossible anyway,” says Spira. “It really is an excruciating condition. If people regard gout as some sort of badge of honour for an indulgent lifestyle, it’s one I could definitely do without!”

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