Oh! when I have the gout, I feel as if I was walking on my eyeballs,’ said the 19th century English essayist, Reverend Sydney Smith. Émile Zola’s description of Chanteau’s gout in The Bright Side of Life is one of literature’s most compelling medical case studies. But while a scourge of Victorian paterfamilias, gout is still with us today. About 1 in 40 UK adults still live with gout, which is the most common inflammatory arthritis worldwide.1
Rates seem to have stabilised in high-income countries. But gout is becoming more common worldwide and affects, for example, up to 14% of people in Asia-Pacific communities.2,3
At first sight, this burden of disease is surprising. Gout’s pathophysiology is well understood.1,3 Inexpensive urate-lowering drugs address the cause.1,3 Indeed, gout is ‘the only common arthritis where the pathogenic agent can be eliminated’.4 Yet in the UK, only 40% of patients receive urate-lowering therapy. 4
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