Gout is a disease with the distinctive personality of an old buffer stuck in the armchair of a gentleman's club, which is why - despite being agonisingly painful - sufferers have to endure smirking and even disapproval from family and friends. Known as the 'disease of kings and the king of diseases' since the 5th century BC, it has long been associated with good living and overindulgence of every kind. Cartoons by Rowlandson, Cruikshank and Hogarth come to mind of stout, ruddy-faced boozers with bloated legs sitting on 'gout' stools next to an empty bottle of port.
No wonder then that when I recently found myself hobbling out of the doctor's having been diagnosed as having gout, I decided I would only tell my mother and my husband (one smirked and the other was disapproving, and I bet you can guess which way round it was). I had been woken suddenly in the early morning by a searing pain in my left big toe, which soon became hot, red and swollen, as well as extremely tender on the sole side of my foot. Later on that morning, I was forced to use a stick to get me from the car into my children's school and then to abandon the car and get a taxi home because I could not bear to push down on the foot pedals. But gout! I simply could not accept the diagnosis. It made me feel unfeminine (gout afflicts eight times as many men as women, and very rarely attacks a pre-menopausal woman) as well as geriatric (my grandfather, who was in India for years and always liked a bit of a snifter, was a sufferer).
As I have never been much of a drinker and have never so much as tasted a glass of port, it also seemed deeply unfair.
The doctor explained that gout is one of the most common types of arthritis which afflicts three in every thousand people. The problem was that I had a build-up of uric acid in my blood which had formed crystals around the joint of my big toe, although the ankle, foot, knee and hand joints may also be affected. Uric acid builds up through increased levels of purines, which are produced by the digestion of certain types of proteins.
There are various reasons for the build-up of uric acid. Some people simply have a genetic tendency to make too much, but for others it can be due to excessive alcohol consumption and eating large amounts of meat, dried peas, seafood and beans, hence the ancient reputation of gout as the disease of the rich. The reason that port, in particular, is associated with gout is that it was often served in lead-crystal glasses, and lead poisoning is thought to be another cause.
I was given a non-steroidal anti-inflammatory drug, and after a few days it cleared up. As there has never been a reoccurrence and I was told that it is perfectly possible to have one attack in a lifetime, I chose to simply forget about my unglamorous affliction. Until, that is, a 39-year-old friend Marco Oddi, slightly liberated me from my shame by admitting that he had suffered from regular bouts of gout for the past seven years. Like me, he rarely drinks and is likely to have inherited his condition.
His most recent attack was a couple of weeks ago, and came just a month after the last one. He still isn't walking with his usual springy step and has acquired a slight shuffle, which I'm afraid to say reminds me a little of my grandfather. Marco has always treated his gout with anti-inflammatory drugs and by cutting out various foods - but naturally enough only does this when the memory of an attack is sufficiently fresh in his mind. He has so far taken drugs only as a reaction to an attack, but has come to the conclusion that he will have to take Allopurinal, a preventative drug that inhibits the formation of uric acid. 'I was resisting this because I'm not really happy about having to take a tablet every day. I have decided to give it a try now, though, otherwise I'll always be dreading the next attack.'
Frank McKenna, consultant rheumatologist at Trafford General Hospital in Manchester, says that those who suffer from hereditary and frequent gout would definitely benefit from taking Allopurinal. 'Another situation in which we would strongly advise taking Allopurinal would be if the patient has started to develop tophi, which are small, hard lumps of uric acid that form under the skin. Allopurinal should be taken after a gout attack has definitely ended because the drug may cause the level of uric acid to rise slightly before it falls, but once levels have been brought down, the patient should be able to live a completely gout-free life.'
A few days later, another young, fit friend, hearing that I am writing about gout, decides to phone and admit that she, too, has had a solitary attack. Jenny Wearing, 35, says that her bout of gout was confirmed by the removal of fluid from the toe joint and the discovery of uric acid crystals. She had been too embarrassed to tell anyone about the diagnosis and had pretended that she had trodden on a nail. In the end, we both decide that although gout is a disease associated with a patrician past, it is still lurking around, cloaked perhaps even from medical statisticians by the embarrassment and mortification of its thoroughly modern victims.
