Thursday January 16 2014
Gout can cause a sudden and severe swelling in the joints
“Britain is the gout capital of Europe with one in 40 people affected by the condition,” the Daily Mirror reports.
Gout is a particularly painful form of arthritis, though unlike many other types, its underlying causes can be treated.
The paper’s headline is based on new research which looked at trends in cases of gout over the last 15 years. It found a significant rise in people affected (incidence) by gout – 29.6% from 1997 to 2012, meaning that around one in 40 people are now affected by gout.
The study also found that many people with gout were not being treated with a type of medicine-based therapy known as urate-lowering therapy or ULT. ULT is designed to prevent the symptoms of gout reoccurring as opposed to treating symptoms when they do occur.
The study found only 18.6% of newly diagnosed (incident) gout patients received ULT within six months and 27.3% within 12 months of diagnosis, however, this may not be a bad thing.
Depending on the severity and frequency of attacks of gout, lifestyle measures may be enough to prevent future attacks.
What is of concern is that in those people who were prescribed ULT, only four out of 10 completed the recommended course.
There are several things you can do to reduce the risk of gout and to make an attack less painful, such as losing weight if you are obese, reducing alcohol intake and dietary intake of foods that contain purines – including red meat and mackerel.
If you are diagnosed with this condition, it’s important to discuss the benefits and risks of ULT with your GP.
Where did the story come from?
The study was carried out by researchers from the University of Nottingham, Keele University and Chang Gung Memorial Hospital, Taiwan.
The study was published in the peer-reviewed, open access journal Annals of Rheumatic Diseases, published by the BMJ. It can be read online here.
It was funded by University of Nottingham and Chang Gung Memorial Hospital.
Generally, press coverage was fair, though most papers took the opportunity to speculate that the rise in cases was due to a corresponding increase in obesity and alcohol consumption – such as the Daily Mail’s headline “Boozy Britain is the gout capital of Europe”.
While such speculation is both entirely plausible and reasonable, the causes of the increase in cases were not investigated in this study.
What kind of research was this?
This was a time-trends study into both the prevalence and incidence of gout among the UK population, for each year from 1997 to 2012.
The prevalence of a disease is the total number of people with the condition, within the population at any given time. Incidence is the number of new cases diagnosed within a specific period, usually a year.
As the authors explain, gout is the most common form of arthritis. It is caused by a build-up of uric acid, a waste product produced by the body, in the blood. This leads crystals of sodium urate, produced by the body, to form inside joints.
The most common symptom is sudden and severe pain in the joint, along with swelling and redness. The joint of the big toe is usually affected, but it can develop in any joint.
Medication which lowers uric acid levels (called urate-lowering therapy or ULT) means gout is the only form of chronic arthritis which can be “cured” say the authors. But it has to be taken regularly.
Data on the number of people suffering gout is sparse and the evidence that does exist is conflicting say the authors.
What did the research involve?
The researchers used a database, called the Clinical Practice Research Datalink (CPRD), to estimate the prevalence and incidence of gout for each year from 1997 to 2012. The CPRD is one of the largest databases of medical records in primary care in the world. It collects anonymous clinical records from 12 million people, about 8% of the UK population.
The study included everyone on the database between 1997 and 2012.
Prevalence and incidence were calculated for 13 regions in the UK: North East, North West, Yorkshire and the Humber, East Midlands, West Midlands, East of England, South West,
South Central, London, South East Coast, Northern Ireland, Scotland and Wales.
They divided the gout patients into four groups according to whether they had been treated, and whether they had adhered to treatment, by looking at records of prescription refills, for each calendar year:
- patients not treated
- patients who had not stuck to their treatment
- patients who had partially stuck to their treatment
- patients who had completely stuck to their treatment
They also assessed how newly diagnosed (incident) gout patients were managed each year by looking at the percentage prescribed ULT at six months and one year after diagnosis.
From this data they determined trends in the prevalence, incidence and management of gout, from 1997 to 2012, standardised for age, sex and the length of time each patient had been on the database.
What were the basic results?
More than 4.5 million eligible people were on the database in 2012:
- 116,000 already had gout, meaning the prevalence of this condition was 2.49%.
- More than 7,000 new diagnoses of gout were made, giving an incidence of 1.77 per 1,000 person-years.
- Between 1997 and 2012, the prevalence of gout rose by 63.9% and the incidence by 29.6%.
- Regions with highest prevalence and incidence were the North East and Wales.
- Among existing (prevalent) gout patients in 2012, 48.48% were being consulted specifically for gout and of these, 37.63% received ULT.
- The management of prevalent and incident gout patients remained essentially the same during the study period, although the percentage of patients who adhered to their treatment improved from 28.28% in 1997 to 39.66% in 2012.
The study also found that men were about four times more likely to be diagnosed with gout than women.
How did the researchers interpret the results?
The authors say their study demonstrates that the burden of gout in the UK is higher than previously thought, with about one in 40 adults now affected. Prevalence and incidence is now the highest reported in Europe.
Despite the rising numbers, management continues to be “suboptimal” with only one in three prevalent patients receiving ULT and only one in four newly diagnosed patients receiving ULT within one year of diagnosis. Patient adherence has improved slightly but remains poor.
They also say the difference in regional variations is most likely due to differences in socioeconomic status, lifestyle and nutrition “…although gout historically was considered a disease of affluence, the converse may now be true”.
As the authors point out, the study has some limitations, which may mean there is a risk of error.
- They based their estimates on diagnoses of gout by GPs, rather than on international classification criteria.
- They based their estimates of how far patients adhered to treatment on records of prescription refills. This may not reflect whether patients took their prescribed pills, or whether their condition improved and they no longer required medication.
- Management of gout is not only with medication but through lifestyle measures, depending on the severity and number of episodes, so describing the care of people who have had an attack of gout as suboptimal because they are not on medication could be misleading.
However, the estimates they have given are likely to be reliable.
There are many things you can do to reduce the risk of gout and to make an attack less painful. Prevention is certainly better than the cure when it comes to gout, as current painkillers are not particularly effective in treating more severe flare-ups.
If you are diagnosed with this condition, it’s important to discuss the benefits and risks of long-term treatment with your GP.
You may want to first consider trying lifestyle changes, such as losing weight, avoiding foods known to trigger flare-ups and avoid binge-drinking alcohol.
If these methods fail to be effective then you may require a course of ULT.
Read more about treatment options for gout.
Analysis by Bazian. Edited by NHS Choices. Follow Behind the Headlines on Twitter.