Patients with debilitating gout are being failed by the NHS because of outdated practices which mean they are prescribed only a third of the medication they need, experts claim.
The condition, a type of arthritis that causes severe pain and swelling in the big toes, feet, wrists and ankles, affects an estimated 1.5 million people in the UK.
And cases are on the rise, with the number surging by about four per cent each year.
Comedians James Corden, 46, and Jack Whitehall, 36, are among celebrities who have suffered with it in recent years.
And last week, The Mail on Sunday’s resident GP Dr Ellie Cannon wrote that her friend, the GP and TV presenter Dr Hilary Jones, has the condition.
In response, we were flooded with letters and emails from readers who also have gout.
One reader, 59-year-old Johnny Watson, said he had experienced random attacks of the condition over the past 20 years, which left his joints feeling like they were being ‘attacked by multiple hot little daggers’ and made him unable to sleep at night.
Another, 85-year-old Pauline Woods, saw four different doctors for gout, which had made her ankles, feet and lower legs so painful and swollen that she could barely stand. Nothing she was prescribed helped.
James Corden is known to have suffered gout in recent years
Another celebrity sufferer is comedian Jack Whitehall. A type of arthritis, it affects an estimated 1.5 million people in the UK
Now experts are calling on the health service to ensure all patients receive the correct treatment.
‘We have a treatment for gout already available on the NHS – the trouble is, it’s not being used
very effectively,’ said Professor Frances Williams, consultant rheumatologist at Guy’s and St Thomas’ NHS Trust.
Patients are usually prescribed colchicine – an anti-inflammatory drug that reduces pain and swelling. And to prevent flare-ups, which are caused by having too much uric acid in the blood, they are put on a daily pill, allopurinol, that blocks its production but has to be taken for the rest of their life. Studies have shown that the drug is very successful in preventing flare-ups.
However, Dr Williams explained, most GPs are only comfortable using the dose recommended in health service guidelines, which is far lower than what the top dose can be.
‘You can’t really treat gout properly without using the full dose. Changing the guidance should see more patients getting the relief they need,’ she said.
Long known as ‘the disease of kings’, gout was famously suffered by monarchs including Henry VIII and Queen Victoria.
It was believed to be triggered by overindulging on rich foods and alcohol. But research now shows anyone can get the disease – though men are four times as likely to as women.
Gout occurs when the body has an inflammatory reaction to urate crystals that form in and around joints. It is diagnosed by measuring uric acid levels in the blood.
Flare-ups can be connected to certain foods – primarily those high in the compound purine, which, when digested by the body, produces urate. These include red meat, offal, sugary drinks, alcohol, cheese and certain vegetables such as asparagus and spinach.
Triggers vary – readers writing to Dr Ellie’s cited venison, haggis and even Marmite.
Some foods, however, can help control gout. Studies have shown that black cherry juice can reduce the number of attacks due to its antioxidant properties, which relieve inflammation. The tartness also helps lower uric acid levels.
For Pauline, from Essex, it was drinking a litre of this a day that helped soothe her symptoms.
‘I have no more swollen feet and no pain. I’ve gone from being stuck in a wheelchair to slowly walking again,’ she said.
But experts are clear the best cure is still medication – if a patient can access it. According to gout charities, only a third of diagnosed patients are prescribed urate-lowering drugs. And a mere one in five received medication within six months of diagnosis.
Then there is the issue with the dosage prescribed. ‘Particularly with allopurinol, health service guidelines advise GPs to prescribe a lower dosage than what is needed,’ said Dr Williams.
According to the British National Formulary, the reference book that advises NHS doctors and pharmacists on how to prescribe medicines, gout patients should take 300mg of allopurinol a day.
But to be effective, this needs to be tripled to 900mg, said Dr Williams, adding: ‘That’s what we prescribe in clinic, and the dosage most need to clear up symptoms. The patient won’t feel any different, but they’ll reduce their risk of another flare-up in the long term.’
GPs also should give patients a second blood test after putting them on the medication to see how well it’s working – an option rarely offered. Dr Williams concluded: ‘We need better education – for patients and doctors – on how to manage the condition, as well as a change to the guidelines.’
