History of Gout
The first major arguments about uric acid playing a central role in gout did not emerge until the nineteenth century. However, it would take another century for the medical community to recognize its involvement in precipitating acute inflammatory gout flare-ups.
Two 1962 publications helped to examine the correlation between uric acid and acute gout attacks. These key publications paved the way for successful urate-lowering drug treatment.
To be clear, gout is by no means an emerging disease. As you’ll see below, gout has been around for most of human history.
It was mentioned in the histories of many important people and first appeared in medical records quite early in the history of medical literature. It was portrayed as both the fate of a wealthy life and a test of a physician’s abilities, and it was.
Gout management has come a long way in the modern day. More recently, we have a better understanding of the disease and a more powerful arsenal thanks to quantum leaps in molecular biology, diagnostic modalities, and pharmacology.
Gout is a common form of arthritis. Like other forms of arthritis, it results in swelling and discomfort in the joints. Gout develops in some persons who have a chronic illness termed “hyperuricemia,” which means excessive amounts of urate (also known as uric acid) in the blood.
Urate crystals can form and collect in many body regions, causing discomfort. It is unknown why up to two-thirds of persons with hyperuricemia do not exhibit any symptoms. Not everyone who has hyperuricemia develops gout.
Some people can develop uric acid crystals that can lead to kidney stones and other problems with kidney function.
Risk Factors for Gout
Gout has been referred to as “the disease of kings” for millennia since it primarily affects men who consume a high-fat diet and alcohol. Gout was first mentioned by physicians in ancient Greek writings, who claimed that only affluent persons could contract the condition.
And when royalty, such as Henry VIII, developed gout, the ailment became popular. In the same way that the French at Versailles copied the royals, Europeans sought after gout as a prestige symbol. Men asserted that gout prevented other illnesses and was even an aphrodisiac in the 16th century.
What brings on gout? Gout is caused by uric acid in the blood, as we now know, but in the past, rich foods were thought to be the more straightforward cause. Gout is characterized by intense pain, frequently in the foot or joints. And although gout may seem like a disease of the past, it is becoming more common in the United States right now.
Gout is more common in adults and less common in children. It is more frequent in adult men (usually between the ages of 30 and 45) than in women (usually after the age of 55); it is most common in persons over the age of 65, regardless of gender.
According to estimates, 4% of adults in the United States suffer from gout.
A person’s chance of acquiring gout is increased by several medical conditions and lifestyle variables, including:
- Excessive eating or fasting
- High blood pressure
- Chronic kidney illness
- Excessive alcohol consumption (especially beer, whiskey, gin, vodka, rum, and other spirits) regularly
- Consuming an excessive amount of meat or fish
- Consuming high fructose corn syrup-containing beverages (such as non-diet sodas)
- Taking drugs that influence urate levels in the blood (especially diuretics)
Certain traits in patients who have already been diagnosed with gout (referred to as “established gout”) enhance the chance of recurrent gout flares. These are some examples:
- A recent injury or operation
- Using drugs that cause abrupt increases in blood urate levels
- Using an excessive amount of alcohol
Common Symptoms of Gout
Gout flares, also known as gout attacks, are sudden assaults of excruciating joint pain that frequently involve redness, swelling, and tenderness. Although a gout flare normally only affects one joint, some persons simultaneously experience inflammation in many joints.
Gout flares occur more frequently at night and early in the morning than during the day, but they can occur at any time. Even if left untreated, pain and inflammation typically peak within 12 to 24 hours and resolve entirely within a few days to several weeks. It’s unclear how the body “switches off” a gout flare.
White blood cells and cells in the joint linings try to encircle and digest urate crystals that have shed from deposits to the fluid that lubricates the joints (called synovial fluid), which causes the distinctive pain and inflammation of gout (called synovial fluid).
A Historical Perspective on Gout
Gouty arthritis was one of the first diseases to be recognized as a unique clinical entity. In the year 2640 BC, Hippocrates, who lived in the fifth century BC, identified podagra, or severe gout affecting the first metatarsophalangeal joint. He called it “the unwalkable disease.”
Some of Hippocrates’ extraordinary clinical observations of gout are preserved in aphorisms that are as relevant now as they were 2500 years ago.
Hippocrates also made the connection between the disease and a sedentary lifestyle. This was about podagra, which was described as an “arthritis of the rich,” as opposed to rheumatism, which was described as an “arthritis of the poor.”
Six centuries later, Galen was the first to describe tophi, which are crystalline monosodium urate deposits induced by chronic hyperuricemia. Galen associated gout with drunkenness and intemperance, but he also recognized a hereditary feature mentioned by the Roman senator Seneca.
First Use of the Word “Gout”
The Dominican monk Randolphus of Bocking, domestic chaplain to the Bishop of Chichester, was the first to refer to podagra as “gout” (1197–1258).
The name comes from the Latin word gutta, which means “drop,” and was used to describe the widespread medieval notion that an excess of one of the four “humors” was bad. The balance between the humors, which was supposed to preserve health, could occasionally “drop” or “flow” into a joint, resulting in discomfort and inflammation.
Gout was later described by Thomas Sydenham, a notable English physician, and proponent of hippocratic medicine. He also suffered from gout and renal illness. He said the following about gout:
“The patient goes to bed and sleeps quietly until about two in the morning when he is awakened by a pain which usually seizes the great toe, but sometimes the heel, the calf of the leg, or the ankle. The pain resembles that of a dislocated bone … and this is immediately succeeded by a chillness, shivering and a slight fever … the pain …, which is mild in the beginning …, grows gradually more violent every hour … so exquisitely painful as not to endure the weight of the clothes nor the shaking of the room from a person walking briskly therein.”
Gout: The Disease of Kings
Alcohol abuse and fatty diets have long been linked to gout. Gout had earned the moniker “disease of kings” because it is inextricably linked to a way of life that, historically at least, was only accessible to the wealthy.
Gout was once thought to be socially desirable since it was so common among the wealthy and influential. For modern-day gout sufferers, this may sound like an outrageous concept. How times have changed!
Gout attacks were once thought to be a preventative measure for graver illnesses, which is a bit odd. Gout “prevents other illnesses and prolongs life … could I cure that gout, should not I have a fever, a palsy, or apoplexy?” according to the author Horace Walpole.
One Doctor Suggested Eating Geese and Kittens to Treat Gout
Gout remedies ranged from acupuncture in ancient China to the consumption of autumn crocuses in the Byzantine Empire. The oddest gout cure, though, was discovered in a 1518 medical text.
Physician Lorenz Fries suggested the following peculiar recipe: “Roast a fat old goose and stuff with chopped kittens, lard, incense, wax, and flour of rye. This must all be eaten, and the dripping applied to the painful joints.”
Reverend Thomas Daffy introduced “Daffy’s Elixir,” his “Health-Bringing Drink” for gout discomfort, around 1650. Although it did not affect pain, the large dosage of senna leaves may have kept patients from thinking about their suffering as they ran around looking for a toilet. Indeed, Daffy.
Gout Starts Going Mainstream
Diet and lifestyle habits that predispose people to hyperuricemia and gout have become more frequent in recent decades. The disparity in gout incidence between Asia and Europe emphasizes the role of dietary purines (derived from meat, seafood, and beer) in the development of gout.
Gout has been relatively uncommon in traditional Asian diets, which often consist of rice and vegetables because they are low in dietary purines. In contrast, the high-meat and certain seafood-based diets of Europe and the United States are linked to hyperuricemia and gout.
A rise in wealth has also been accompanied by an increase in the population of those living westernized lifestyles and eating westernized food. Gout incidence and prevalence have increased globally in tandem with this.
Gout has traditionally been thought to be primarily a male ailment. Seneca recognized the idea that women can suffer gout during the reign of Nero (AD 54-68). “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 gout?” he observed.
Although gout is still largely a disease of men in their forties, it is becoming more common in women, particularly after menopause.
The Evolution of Gout Over the Centuries
One of the earliest known diseases, gout significantly lowers a patient’s quality of life. It’s intriguing to see how many professionals, using their knowledge and the tools at their disposal, describe the same medical problem.
The history of gout across various eras has been the subject of numerous publications over the years. Let’s quickly move across history to examine how people perceived gout during various eras.
- The Ancient Egyptians (2640 B.C.): In 2640 B.C., the Ancient Egyptians discovered uric acid. Hippocrates(460-370 B.C.) recognized gout as the result of an excess of one of the four bodily humors, phlegm, which severely damaged the joint.Hippocrates referred to gout as the “unwalkable sickness” and the “arthritis of the rich” due to the wealthy’s lifestyle. This included an abundance of food and wine. He also believed that gout was more common in postpubertal men and postmenopausal women.
- Galen (215 AD): Six centuries later, in 215 AD, Galen characterized tophi as a symptom of chronic gout and under-the-skin crystallized uric acid masses.
- Ruphus of Ephesus ( 1st century): Ruphus felt that gouty humor might influence internal organs, causing pulmonary, brain, and renal failure and death.
- Oribasius (400 CE): Gout, according to Oribasius, affects the feet, whereas arthritis affects the hands, knees, and elbow.
- Randolphus of Bocking (1197-1258): Randolphus of Bocking (1197-1258), a Dominican monk, termed gout podagra. The phrase is derived from the Latin word gutta (drop), which is a drop or flow into the joint that causes pain and inflammation due to the formation of uric acid crystals within the joint.
- Antoni var Leeuwenhock (1632-1723): Antoni was the first to describe the appearance of crystals from gouty tophi under the microscope.
- Alfred Garrod (1819-1907): Alfred developed the uric acid danger test, which relied on the crystallization of urate on linen thread and could be regulated by reducing purine-rich food consumption. At the end of the nineteenth century, drugs such as probenecid, fenofibrate, allopurinol, and NSAIDs were identified to produce uricosuria and resolve tophi.
- Emile Fischer (1902): Fischer, a German chemist who earned the Nobel Prize in 1902, discovered that purines contained in meat, fish, and alcohol cause the formation of uric acid.
Gout Myths vs the Facts
As you can probably tell, there has been no shortage of misconceptions about gout throughout history. Even though we now know a lot more about gout and how to treat it, a few myths persist in some people’s minds.
Unfortunately, in many cases, gout is not treated seriously, and the patient is frequently blamed for the ailment. Here are some typical gout beliefs, along with the truth.
Common myths about gout:
- “Gout is uncommon”: Gout is a rather prevalent ailment, with over 8 million Americans suffering from it, and the number is growing. Gout is the most frequent kind of arthritis in males over 40.
- “Gout affects men only”: Gout can affect both men and women. Though males are 10 times more likely than women to get gout, rates of gout tend to even out at the age of 60 since gout develops after menopause in women.
- “Gout affects just obese people”: Gout can affect people of various sizes. Though obese persons are at a higher risk, gout is more common among people who have diabetes, high blood pressure, high cholesterol, or kidney disease.
- “Gout affects only the big toe”: The big toe is the most common location for gout attacks, and many patients experience their first gout attack there. However, gout can occur in any joint of the body, including the hands, elbows, knees, and ankles. When patients have chronic gout, it is common for numerous joints to be afflicted.
- “Gout ultimately disappears on its own”: Although the signs and symptoms of a gout attack typically fade away after a few days, this does not mean that the gout is completely gone. Urate crystals in the body can cause long-term health problems like joint and kidney damage even if you don’t experience any symptoms.
- “There are foods I can eat and avoid to prevent or cure gout”: If you are prone to gout, there may be foods you should avoid, and certain foods you eat may assist to lower the quantity of uric acid in your body. Alcoholic beverages, particularly beer, and organ meats such as liver, as well as some fish such as anchovies and sardines, are high in a class of natural chemicals known as purines. Because the body produces uric acid when purines are broken down, consuming a lot of purine-rich meals raises the chance of an attack.It’s important to keep in mind that nutrition alone is not a cure. People with gout who eat a healthy diet may still require medications to prevent gout attacks by reducing uric acid levels in their bodies.
If you suspect you have gout, consult your doctor about your symptoms. If you have gout and are having symptoms, consult your doctor about treatment options. You may need to see a rheumatologist, or arthritis specialist, who specializes in gout.
Gout stages over time
Fortunately, gout is now one of the most treatable kinds of arthritis, with some rheumatologists even claiming that it can be cured. However, far too many gout sufferers go untreated or undertreated.
In one recent study, for example, just 37% of gout patients were taking the uric acid-lowering medicine allopurinol. Barely half of those gout patients with regular flares were using it.
Gout is a degenerative disease that can permanently damage joint structures over time. Having one episode of gout does not raise the risk of having another flare-up. However, the crystals that form in the joints can damage the cartilage and the inflammation can affect the joint tissues. Osteoarthritis develops when the joint tissue and cartilage get overly damaged over time.
The Progression of Gout in 4 Stages
Stage #1) High Levels of Uric Acid
In the early stages of gout, also known as asymptomatic hyperuricemia. This is when uric acid builds up in the blood and begins to crystallize around joints, most frequently the foot.
Purines, which are produced by your body and can also be found in some foods and beverages, are broken down by your body to form uric acid. Many specialists feel that the importance of nutrition in the development of gout is overstated. This is even though eating foods high in purines can lead to elevated levels of uric acid.
Chronically high uric acid levels are a sign that your kidneys can’t effectively remove uric acid. This can happen for a variety of causes as previously mentioned.
Stage #2) Gout flare-up
Gout flares normally begin with a single joint, most commonly the big toe or knee. Flares can get more severe over time, involving numerous joints at once, and may be accompanied by fever.
People with finger osteoarthritis may have their first gout flares in their fingers rather than their toes or knees.
Stage #3) The intercritical gout
An “intercritical” phase is the time between gout episodes. A second gout flare usually occurs within two years, and more gout flares are possible.
If your gout goes untreated for a long time, the interval between flare-ups may shorten. Your gout flares may then grow more severe and persistent, involving several joints.
Stage #4) Tophaceous gout
Tophaceous gout can occur in people who have chronic hyperuricemia or recurrent gout attacks. This phrase refers to the buildup of many urate crystals in masses referred to as “tophi.”
People who have this type of gout develop tophi in the skin, bones, cartilage, bursae (the fluid-filled sacs that cushion and protect tissues), joints, and bursae. Tophi may result in bone degradation, joint degeneration, and eventual deformity (called gouty arthropathy).
The physical changes brought on by tophi at the tiny joints of the foot or fingers can be upsetting (because of the visual look), but they can also lead to limited mobility and impairment. They might cause the joint to act as a “chalk splint,” which could lead to lesions in the bone and joints in the long run.
We hope you’ve found this comprehensive overview of gout throughout the centuries quite helpful. It is also my aim to educate people about the risks of falling for common misconceptions.
You should always check with your healthcare provider for the best treatments that are suitable for your particular situation. Remember, you should always try to avoid provoking your gout symptoms when possible.
But with proper treatment and lifestyle changes, you won’t have to live your life in fear.
Posted by Spiro Koulouris