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The Guardian - UK
The Guardian - UK

Gout: the myths and the medicine

The Gout - a 1799 cartoon by James Gillray depicting the pain caused by the disease
The Gout, a 1799 cartoon by James Gillray depicting the pain caused by the disease. Photograph: Lordprice Collection/Alamy

Daniel Lavelle is mentions that gout was historically called “the rich man’s disease” (At 35, I found out I had gout. Imagine having to give up everything you like to eat and drink, 29 November). It was also known as “the disease of kings”, but we now know that its main similarity with royalty is a predilection for certain genes. Lavelle’s article was enjoyable, but perpetuates the misconception that gout is fundamentally a lifestyle disease. This misconception can lead to shame and stigma for some patients.

Research has relatively recently confirmed that the association between diet and gout is far weaker than previously thought. The underlying driver of gout is uric acid crystals in the joints. There is evidence that diet accounts for no more than 1% of the variation in uric acid levels between people. In contrast, genetics has a tremendously greater impact on the risk of developing gout than any other risk factor. Moreover, well-meaning dietary rules can be burdensome and confusing.

For these reasons, the updated UK guidance on gout for doctors issued by the National Institute for Health and Care Excellence recommends that we promote a healthy weight and avoidance of excessive alcohol. Doctors are no longer advised to recommend a list of certain foods to be avoided for patients with gout.

The evolution of the medical understanding of gout demonstrates why received wisdom as a basis of belief is best taken with a pinch of salt.
Dr Ayo Ajanaku
General practitioner, Reading, Berkshire

• I had a similar experience with gout. I suffered with it for a couple of years until I found a GP that prescribed me allopurinol, which is a preventive drug for gout flare-up. It’s been 30 years now since I’ve been taking it, with no side-effects and no gout. Anyone currently suffering with gout should ask their GP for this treatment rather than trying to avoid eating purines – they are in all foods, good or bad.
Kevin Hughes
Cheadle, Greater Manchester

• I read Daniel Lavelle’s article about gout with great interest, as I also developed this condition at a similar age, when I was 33. After suffering for 20 years and trying to control it with a low-purine diet – no alcohol, no cheese etc – which had less and less effect, I was given a new drug that changed my life: febuxostat.

Most people can control gout with a drug called allopurinol, but I found very quickly that I was intolerant. I only found out about febuxostat because my wife insisted that I asked to be referred to a specialist in rheumatology. My GP had been reluctant to prescribe the new drug, because there can be serious side-effects. However, I have avoided these, and since starting on this drug, I have not had a single episode of gout, despite eating and normal food and having a few alcoholic drinks per week. I still avoid red wine, though – I don’t want to push my luck!
Jared West

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