Gout is back in Italy, overweight men increasingly at risk

It was once known as the disease of the nobility, who could enjoy a very plentiful diet particularly rich in meat. In 18th century England, suffering from gout was even considered a sign of social distinction: it signified belonging to a wealthy class. But this disease, studied at length even by Hippocrates, has not only never been eradicated, as we are commonly led to believe, but is on the rise all over the world, including in Italy where it now affects 1% of the adult population.

'We are talking about a disease that is one of the most common forms of inflammatory arthritis,' says Carlomaurizio Montecucco, Professor of Rheumatology at the University of Pavia at the Policlinico San Matteo. 'It is a disease that can be cured and that is often underestimated despite the severe pain it can cause in the joints, generally at the base of the big toe or at the level of the knees or ankles. Caused by the accumulation of uric acid crystals, it mainly affects overweight or obese men with poor eating habits and can also occur at a young age. It is very difficult, however, to find it in women, who at least until the menopause are protected by oestrogen. It always has, in any case, a genetic basis: the elimination of uric acid is in fact regulated by proteins guided by genes. 'And this helps explain why in ancient times it was widespread among aristocrats, who were accustomed to interbreeding,' explains Montecucco.

Amid myths to dispel and legends, one thing is certain: gout is now widespread globally. Linked to overeating, it has also appeared in China, where it had never manifested itself for centuries. And it is often associated with other diseases such as hypertension, diabetes, metabolic syndrome and cardiovascular diseases. It is part of the class of rheumatological diseases that afflict around 5 million people in Italy, costing the national health service an estimated 20 billion a year. 'Any family doctor can diagnose it,' Montecucco continues. 'It presents itself suddenly, with very violent inflammation sometimes accompanied by fever. Then it regresses on its own only to appear again, sometimes after years. This is another reason why it is often taken lightly. Although over time the interval between attacks generally becomes shorter and shorter'. The risk factors acting on the genetic predisposition are various and can be traced first of all to diets that include a lot of offal, liver, innards and a high consumption of beer, which is very pathogenic due to substances that stimulate the production of uric acid. 'In general, it is always better not to abuse alcoholic beverages or beverages sweetened with fructose, such as orangeade or Coca-Cola,' adds Montecucco, who is also president of Fira, the Italian Foundation for Research in Rheumatology.

A healthy, varied and balanced diet is the mainstay of gout prevention, often accompanied by so-called tophi, accumulations of uric acid under the skin that appear as lumps on the hands, feet or elbows. There are specific drugs on the market to reduce uric acid production. However, it must be said that the treatment of gout is characterised by a paradoxical effect: the treatment can trigger other attacks (and for particularly violent ones, cortisone can be used). To prevent them, colchicine, a drug that has been known for at least 150 years, is used. The paradoxical effect is due to the reduction of uric acid levels (when they drop, the deposits dissolve causing pain and inflammation again) and can discourage patients. 'But it is good to treat yourself,' warns Montecucco, 'while at the same time always trying to control your weight.