Gout not just for Victorians: 1 in 40 Brits have this extremely painful disease

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If you thought gout was an outdated condition affecting portly, red-faced Victorians, think again.1 in 40 Brits now have this extremely painful disease, making it the UK’s most common form of inflammatory arthritis. Cases among people in their 20s and 30s have increased by 30%, and faster monitoring and treatment is needed, says a leading expert.

Many of us have a mental image of gout sufferers as plump, elderly Victorian gents who drank too much port. Nothing could be further from the truth. The most recent figures reveal 1 in 40 Brits are now suffering from this extremely painful condition, making it the most common form of inflammatory arthritis, and cases have escalated by 30% among younger people in their 20s and 30s.

In more than half of all cases, gout classically manifests as a severely painful, red and hot joint in the big toe. It can then spread to the rest of our feet and hands and even become disabling. Gout is caused by the accumulation of uric acid in blood and tissues, which forms crystals. If these crystals get into a joint, they can trigger inflammation.

Gout flares, as they are called, can be agonising. Yet a leading health expert says it is the only form of arthritis that is entirely curable with treatment and cases can by eliminated by regular monitoring.

Dr Avinash Hari Narayanan (MBChB), Clinical Lead at London Medical Laboratory, says: ‘Unfortunately, gout is a condition that is very much still with us, despite the fact that simple blood tests can help identify people likely to suffer a flare before it ever happens.

‘The charity Arthritis Action says 1 in 40 Brits now have the condition and it can lead to debilitating pain, even for younger people.  A study published in the journal BMC Primary Care last November found gout is the most common inflammatory arthritis yet, frequently, it is not managed well enough or taken seriously.

‘The report found the medical management of gout is typically focused on the treatment of flares through lifestyle modification. Even though successful treatment using urate (uric acid) lowering therapies (ULT) has seen consistent results over 20 years, in the UK only around a third of people with gout are treated with ULT and the report found adherence to treatment is poor.

‘This finding was echoed by another report released last year in The Lancet Rheumatology. It found that “inconsistent recommendations about when to initiate urate-lowering therapy are likely to increase uncertainty around disease management.” Crucially, this paper agreed that: “Poor adherence to therapy is also a concern, particularly in dormant periods between flares.” Again, regular monitoring using simple finger-prick blood tests can help people stick to their target levels.

‘The last major UK study into the condition was held as long ago as 2012. At that time, a report in the British Medical Journal’s (BMJ) Annals of the Rheumatic Diseases revealed cases were significantly higher in 2012 than in 1997, the date of the preceding major study, with a 63.9% increase in prevalence and 29.6% increase in incidence over this period. Concerningly, although most gout patients were still 60 or older, the number of patients aged between 20 and 30 had increased by 30%.

‘In some ways, there has been little advance since 2012. NHS Digital statistics show that 234,000 people were admitted to hospital with gout in 2021-2022. The 2023 BMC Primary Care report examined 51,784 cases of people with the disease and found 35.9% suffered at least one more flare during the study period.  It found cases of gout flares are more likely in people who are male, Black, have a higher BMI, suffer from heart failure, chronic kidney disease (CKD), cardiovascular disease (CVD) or who take diuretics.

‘Urate lowering therapies were used in just 27.7% of cases within 12 months of diagnosis, despite the potentially debilitating impact of recurring flares. One of the chief problems the BMC report identified is that many patients give up their treatment, because achieving target urate levels can be challenging.

‘Yet simple blood tests, such as London Medical Laboratory’s General Health Profile finger-prick test, can quickly and accurately measure urate levels in the blood to help people meet their targets and avoid subsequent flares. Knowing uric acid levels can also better inform medical professionals when ULT treatment might be necessary alongside other treatments, such as dietary restrictions.

‘Crucially, by taking a General Health Profile blood test, people can identify if they have high urate levels and are at risk of suffering a very painful gout flare before it happens.

‘Not only does the test identify high levels of uric acid, but also muscle and bone profile, liver and kidney function, risk of diabetes (by checking levels of HbA1c), cholesterol levels and iron levels. London Medical Laboratory’s General Health Profile blood test can be taken at home through the post, or at one of the many drop-in clinics that offer these tests across London and nationwide in over 120 selected pharmacies and health stores.

Source:
Journal reference:

The Lancet Rheumatology., (2023). The painful truth of gout in the UK. The Lancet Rheumatology. https://doi.org/10.1016/s2665-9913(23)00245-x.

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