With a history spanning more than 2500 years, gout is among the oldest recognized diseases. Gout is a painful form of arthritis that affects about 1 to 2% of the Western population at some point in their lives.

Throughout history, gout has been associated with rich foods and excessive alcohol consumption Gout was historically known as “the disease of kings” or “rich man’s disease”. It has been recognized at least since the time of the ancient Egyptians.

 

A man suffering from Gout depicted by demons prodding his foot with arrows.

Gout is caused by high levels of uric acid in the body. Sufferers know that gout attacks can occur without warning, resulting in severe pain and swelling or joints, like fingers, toes, knees and elbows.

Factors that influence rates of gout, include age, race, and the season of the year. In men over 30 and women over 50, rates are 2%

Primarily a Male Disease

Historically, gout has been considered to be primarily a male disease. The fact that women can also develop gout was first recognized during the reign of Nero (AD 54–68) by Seneca, who observed,

“in this age, women rival men in every kind of lasciviousness … why need we then be surprised at seeing so many of the female sex afflicted with the gout?”

Throughout history gout has been associated with rich foods and excessive alcohol consumption. Because it is clearly associated with a lifestyle that, at least in the past, could only be afforded by the affluent, gout has been referred to as the ‘disease of kings’

A self indulgent man suffering a Gout attack. Image via Wellcome Collection

“Will it cure this cursed pain I have in my toe?”

Dr William Sidney Charles Copeman refers to a comment in the London Times in 1900,

“The common cold is well named – but the gout seems instantly to raise the patient’s social status”,

and to another in Punch in 1964,

“In keeping with the spirit of more democratic times, gout is becoming less upper-class and is now open to all … It is ridiculous that a man should be barred from enjoying gout because he went to the wrong school.”

Identified by the Egyptians

First identified by the Egyptians in 2640 BC, podagra (acute gout occurring in the first metatarsophalangeal joint) was later recognized by Hippocrates in the fifth century BC, who referred to it as ‘the unwalkable disease’.

The term “Gout”  is derived from the Latin word gutta, meaning “a drop” (of liquid), and referred to the medieval belief that an excess of one of the four ‘humors’ – which in equilibrium were thought to maintain health – would, under certain circumstances, ‘drop’ or flow into a joint, causing pain and inflammation.

Love your enemies?!

Dominican Monk first to use the term Gout

The first person to use the word ‘gout’ to describe podagra (gutta quam podagram vel artiticam vocant – ‘the gout that is called podagra or arthritis’) was the Dominican monk Randolphus of Bocking, domestic chaplain to the Bishop of Chichester (1197–1258)

Uric Acid Crystals as a factor in Gout

The crystallization of uric acid, often related to relatively high levels in the blood, is the underlying cause of gout. This can occur because of diet, genetic predisposition, or under excretion of urate, the salts of uric acid.

Antoni van Leeuwenhoek (1632–1723), one of the pioneers of microscopy, was the first to describe the appearance of the crystals from a gouty tophus.

Fifty-five years later the physician and noted antiquarian William Stukeley, who also suffered from gout, described the crystals from a tophaceous joint. In 1776 the chemical identity of uric acid was first established as a constituent of a renal calculus by the Swedish chemist Scheele.

Genetic Factors

It was recognized that gout could be inherited as early as the second century AD by the distinguished Cappadocian physician Aretaeus, who described what he called a gouty ‘diathesis’. However, it was to be the 18th century before gout became associated with certain external, and possibly inherited, physical characteristics by the Edinburgh physician William Cullen, who wrote,

“The gout attacks men of especially robust and large bodies, men of large heads … and men whose skins are covered with a thick rete mucosum with coarse surface … especially men of a choleric-sanguine type … [whose fathers had suffered]”

It was not until 1931 that Sir Archibald Garrod (the son of Sir Alfred Garrod) suggested that gout be included among disorders that could result from ”inborn errors of metabolism.

We now know that Gout is partly genetic, contributing to about 60% of variability in uric acid level.

Image by James Gillray. Punch cures the Gout?

Advances and the Development of Effective Therapies

During the past 50 years advances in understanding the causes and pathophysiology of hyperuricemia and gout, have led to the development of effective therapies. As a result gout has become a paradigm for the rational treatment and prevention of a chronic rheumatic disease.

The Gout. James Gillray