This article is republished from The Conversation under a Creative Commons license.
"The Gout," by James Gillray, 1799. Wellcome Collection, Public Domain.
“The Queen’s had an attack of gout! Hurry!”
So exclaimed the crotchety Mrs Meg in Yorgos Lanthimos’s The Favorite, in which Olivia Colman plays a moribund and overweight Queen Anne. The queen was afflicted with, among many other conditions, gout—a disorder which causes joint inflammation and severe pain.
In the film, while screaming out in pain, her swollen feet are wrapped in strips of soothing beef. The next day her soon-to-be new favorite, Abigail, collects wild herbs to make a poultice for her. A bit more effective than raw steak, she finds.
You’ve got to feel sorry for Queen Anne. She really didn’t have much of a chance, since doctors of her day had no options for treating gout other than quackery.
She may have been subject to many other absurd treatments of the time to alleviate the symptoms, like scorching the blood vessels supplying the feet, slathering them in goose fat, or bloodletting with leeches. By the time she passed away in 1714 aged just 49, death may have come as a welcome relief.
Queen Anne wasn’t the only member of royalty to suffer with gout. Prince Regent George (later George IV) was similarly afflicted. Gout, then, came to be associated with the aristocracy and over indulgence.
Gout still affects many people. In fact, it is estimated that in 2020 gout affected nearly 56 million people worldwide, a figure that’s predicted to grow to 96 million by 2050. So, a condition that was once considered the disease of kings and queens is a now a disease of the masses, with younger patients also being diagnosed.
Luckily, raw meat strips and herbs are no longer required. We now know much more about how to treat gout and how to prevent it recurring.
The gouty King George IV, colored etching by W. Heath, 1824 Wellcome Collection, Public Domain.
Understanding Gout
Gout is a crystal arthropathy—a group of joint disorders that occur when crystals build up in joints and soft tissues. Gout develops when uric acid levels rise in the bloodstream, before infiltrating the joints where it solidifies and becomes needle-like crystals that inflame the joints, making them incredibly sore.
And when I say “sore,” I really do mean sore: many people who experience gout often describe it as one of the worst pains they have ever felt. It most commonly affects the big toe and it can make even the lightest touch to the skin unbearable.
Some gout patients sleep with a special cage over their foot that lifts up the bedclothes because they can’t bear even the weight of a bed sheet on the affected joint.
Gout can affect other joints. It may also cause “tophi” to develop (hard swellings around joints and the ears).
A self-indulgent man afflicted with gout, the pain is represented by a demon burning his foot. "Introduction of the Gout," colored lithograph by G. Cruikshank, 1818, after Captain Hehl. Wellcome Collection, Public Domain.
Gout typically occurs in bouts or attacks, before settling with treatment and becoming dormant. But it can reoccur, requiring more acute treatment.
A diagnosis of gout is based around the classic symptoms: excruciating pain, swelling in and around the affected joint and redness. Microscopic examination of the fluid taken from the swollen joint may also show crystals and there is usually raised uric acid levels on blood tests.
High Uric Acid
High uric acid levels are usually linked to alcohol excess, obesity, diabetes and hypertension. A diet high in purine-rich foods has been found to have the strongest association.
Purines are compounds comprised of uric acid. Purine-rich foods include meat and offal, oily fish like mackerel and anchovies, and yeasty foods, like Marmite and beer. It may be a good idea to avoid these foods in excess if you suffer from frequent episodes of gout.
A gouty man at table with a bon viveur drinking champagne. Colored etching by T.L. Busby, 1826. Wellcome Collection, Public Domain.
Medication
But dietary changes alone are unlikely to stave off symptoms of gout. Medications can treat both an acute episode of gout and prevent it recurring.
When the joints are inflamed, options include anti-inflammatory drugs like ibuprofen, naproxen or steroid medications. Another option is colchicine, which is typically used for short periods and can be very effective—though it commonly causes bouts of diarrhea.
When the inflammation has settled down, it is important to prevent future attacks. Allopurinol can reduce uric acid levels and therefore the risk of further bouts. There’s also evidence to suggest that eating cherries or drinking tart cherry juice could reduce the risk of gout attacks, especially if combined with alloprinol.
If you want to stay free of gout then perhaps it’s time to consider taking preventative action by making subtle lifestyle modifications. Maintain a healthy weight, eat a balanced diet, cut down on alcohol and avoid binge drinking, take regular exercise and keep yourself well hydrated.
Dan Baumgardt, Senior Lecturer, School of Physiology, Pharmacology and Neuroscience, University of Bristol
This article is republished from The Conversation under a Creative Commons license. Read the original article.
