Gout Is No Joke

Misinformation and shaming may prevent people from getting appropriate care.

By Linda Rath

“Gout is so 18th century. It’s like, why don’t I get scarlet fever and syphilis as well, while I’m about it?”  – Columnist and restaurant critic Giles Coren, The Times, September 13, 2014

That’s just one of hundreds of gout jokes, cartoons and snide jabs that have been spied in the media in the past few years — and that doesn’t take into account a rich tradition of gout lampoonery dating back at least to the 18th century. (Google “James Gillray.”) Then or now, it’s hard to imagine another disease that gets so little respect. And that’s a problem, according to New Zealand researchers. They say the press perpetuates myths about gout that downplay its seriousness and prevent sufferers from getting treatment.

Academic rheumatologist Nicola Dalbeth, MD, and colleagues at Auckland University analyzed 114 articles about gout that appeared in newspapers from 2010 to 2015 in the United States and the United Kingdom. Although most of papers were tabloids, a few were journalistic icons such as The New York Times, The Guardian and The Washington Post. Their findings were published in Arthritis Care & Research.

Dr. Dalbeth says previous research showed that patients, their families and even health care providers believe gout is an embarrassing condition caused mainly by overindulgence in alcohol and rich food. And the investigators found that those same beliefs are also widespread in the popular press.

Of the 114 articles analyzed, 72 said excess food and drink was the main cause of gout. One Wall Street Journal article captured the general tone, writing, “Something about gout conjures up dissolute slobs slouched in wing chairs downing vast tankards of mead.” Only 46 articles mentioned biological risk factors, such as genetics or kidney disease.

Many news stories referred to gout as “socially embarrassing,” and nearly one-third made jokes or humorous references to it.

Fewer than half the articles discussed gout management strategies, and most of those focused on dietary advice. Twenty-nine mentioned anti-inflammatory drugs and 42 described urate-lowering drugs such as allopurinol or febuxostat.

Dr. Dalbeth says the study underscores the differences between the public and medical understanding of gout and suggests that many people with the disease may be too embarrassed to see a doctor or think they can treat flares with diet alone.

More Than a Swollen Toe

Gout results from higher-than-normal levels of uric acid in the blood, a chemical that forms when the body breaks down compounds called purines. Normally, the kidneys process the uric acid, removing it from the blood and eliminating it through the urine. In gout, the excess acid builds up and forms sharp crystals that collect in a joint. That crystal buildup causes the gout attack, episodes of intense pain, heat and swelling in one or more joints. The big toe is often affected — to the endless amusement of cartoonists.

About two-thirds of uric acid is produced naturally by the body. The rest comes from diet, which is why limiting or avoiding high-purine foods has always played a role in gout management and why gout diet is mentioned so often in the press.

But Dr. Dalbeth says recent studies have shown that factors other than diet are also associated with an increased risk of gout, including genetic predisposition and kidney problems. Certain medications can cause gout, too, but changing to another medication usually takes care of the problem.

“A healthy lifestyle is important for all patients with arthritis, including those with gout. That means reducing alcohol intake, maintaining a healthy weight and avoiding sugar-sweetened drinks,” she says. “However, there is very little evidence that nonpharmaceutical treatments alone have clinical benefit in gout. In contrast, there is very good evidence that medications that reduce blood urate levels can dissolve gout crystals, prevent flares and improve function.”

N. Lawrence Edwards, MD, a rheumatologist and professor at the University of Florida in Gainesville and chairman of the Gout & Uric Acid Education Society, agrees.

“The over-emphasis on which foods to eliminate from the diet contributes to the overall poor management of gout,” he says. “Part of people’s reluctance to see a physician about this very painful form of arthritis is the fear that they will be told to give up steak or beer or shellfish [because] they read this advice in newspapers or [heard] it from their friends.”

Dr. Edwards, who was not involved in the study, says the other common myth highlighted by the New Zealand group is that gout is a disease of over-indulgence.

“While the gout epidemic and the obesity epidemic have paralleled each other and the risk of developing gout is higher in people who are overweight, gout is far more complicated than the public perception,” he says. “The perpetuation of these myths is detrimental to optimal care of patients and puts an unfair burden on people suffering from this painful and serious disease.”

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