The Queen’s Gout: A Royal Affliction

A Royal Sufferer

In Yorgos Lanthimos’s The Favourite, Queen Anne, played by Olivia Colman, is portrayed as a moribund and overweight monarch. Her condition is marked by gout, a disorder that causes joint inflammation and severe pain. The film shows her screaming out in pain, with her swollen feet wrapped in strips of soothing beef. The next day, her soon-to-be new favourite, Abigail, collects wild herbs to make a poultice for her.

A History of Quackery

In the 18th century, doctors had limited options for treating gout, and Queen Anne was no exception. She may have been subjected to many other absurd treatments, such as scorching the blood vessels supplying the feet, slathering them in goose fat, or bloodletting with leeches. By the time she passed away in 1714 at the age of 49, death may have come as a welcome relief.

A Royal Affliction

Gout was not unique to Queen Anne. Prince Regent George (later George IV) was also afflicted with the condition. Gout, then, was associated with the aristocracy and overindulgence. Today, however, it affects nearly 56 million people worldwide, a figure predicted to grow to 96 million by 2050. Younger patients are also being diagnosed with the condition.

Understanding Gout

Gout is a crystal arthropathy, a group of joint disorders that occur when crystals build up in joints and soft tissues. It develops when uric acid levels rise in the bloodstream, before infiltrating the joints where it solidifies and becomes needle-like crystals that inflame the joints, making them incredibly sore.

Treatment and Prevention

Gout can affect other joints, and it may also cause “tophi” to develop (hard swellings around joints and the ears). Gout typically occurs in bouts or attacks, before settling with treatment and becoming dormant. But it can reoccur, requiring more acute treatment.

A diagnosis of gout is based on classic symptoms: excruciating pain, swelling in and around the affected joint, and redness. Microscopic examination of the fluid taken from the swollen joint may also show crystals, and there is usually raised uric acid levels on blood tests.

High Uric Acid

High uric acid levels are usually linked to alcohol excess, obesity, diabetes, and hypertension. A diet high in purine-rich foods has been found to have the strongest association. Purines are compounds comprised of uric acid. Purine-rich foods include meat and offal, oily fish like mackerel and anchovies, and yeasty foods, like Marmite and beer. It may be a good idea to avoid these foods in excess if you suffer from frequent episodes of gout.

Medication

Dietary changes alone are unlikely to stave off symptoms of gout. Medications can treat both an acute episode of gout and prevent it recurring. When the joints are inflamed, options include anti-inflammatory drugs like ibuprofen, naproxen, or steroid medications. Another option is colchicine, which is typically used for short periods and can be very effective – though it commonly causes bouts of diarrhoea.

Conclusion

Gout is a complex condition that requires a comprehensive approach to treatment and management. By understanding the underlying causes of gout and making lifestyle modifications, individuals can reduce their risk of experiencing future episodes. Maintaining a healthy weight, eating a balanced diet, cutting down on alcohol, and taking regular exercise can all help to reduce the risk of gout.

FAQs

* What is gout?
Gout is a crystal arthropathy, a group of joint disorders that occur when crystals build up in joints and soft tissues.
* What are the symptoms of gout?
The classic symptoms of gout include excruciating pain, swelling in and around the affected joint, and redness.
* How is gout diagnosed?
Gout is diagnosed based on the classic symptoms and microscopic examination of the fluid taken from the swollen joint.
* What is the treatment for gout?
The treatment for gout typically includes anti-inflammatory drugs, colchicine, and allopurinol to reduce uric acid levels.
* Can gout be prevented?
Gout can be prevented by maintaining a healthy weight, eating a balanced diet, cutting down on alcohol, and taking regular exercise.