Dr Oli: Diving and gout

Q: I am recovering from an acute gout attack, and my knee remains swollen and inflamed, but improving on a daily basis. I am on allopurinol for the gout and naproxen for the inflammation. I do not foresee this presenting physical challenges to my diving - I now have sufficient painless movement in the knee to swim and fin comfortably. My question rather relates to whether an inflamed knee would be more susceptible to DCS than normal. I have never suffered with DCS to date. I hope to be diving in three weeks time with my 11-year-old, so depths will be no more than 12m, two dives per day, but every other day.

A: 'The unwalkable disease', 'the disease of kings', 'rich man's disease' - all terms used to describe this nasty inflammatory arthritis which can affect any joint, but seems to target the big toe most often. The word 'gout' was first used by the absurdly-monikered Dominican monk Randolphus of Bocking around 1200AD, although the first case recorded goes way back to an Egyptian king in 2600BC. It has always been associated with decadent living, excessive alcohol and rich foods - and so is getting commoner in the UK, with one in 40 people affected, and numbers increasing steadily. The actual cause is precipitation of crystals of uric acid called 'tophi' in joints, tendons and surrounding tissues. Most mammals have an enzyme called uricase that breaks down uric acid to constituents easily excreted via the kidneys; but for some reason, humans (and interestingly the other great apes) have lost the ability to make this enzyme. It's only because chimps don't have easy access to Chateauneuf du Pape and Roquefort that they are still swinging through trees, not falling out of them clutching their gouty knees in agony.

So, a plant-based herbivorous diet for you my friend, coupled with plenty of water, should reduce the risk of future episodes; as well as allopurinol, which inhibits the synthesis of uric acid. Although in theory the increased blood flow to the inflamed joint might bolster the bubble count in the area, I've not seen any convincing evidence to support an increase in DCS risk. I think your cautious approach in terms of depths, numbers and frequency of dives, is eminently sensible. And now, back to the port and stilton.

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