Gout: what kind of disease is it and why is it called the disease of kings

Gout is an inflammatory arthritis: a joint suddenly becomes painful and swollen, and the skin over it turns red and feels hot. Most often the first attack occurs in the big toe. Below: what kind of disease it is, where the name "disease of kings" came from, and how it is recognized.

Gout: what kind of disease is it

Gout is a systemic chronic metabolic disease: crystals of urates in the form of sodium monourate or uric acid are deposited in tissues. It manifests as recurrent acute arthritis, gouty tophi nodules, and kidney damage.

An attack comes as a flare: it starts suddenly, often at night, lasts one to two weeks, and subsides. Between attacks there may be no symptoms at all, but without treatment attacks become more frequent and longer, and joints are damaged.

Why gout is called the disease of kings

From the Middle Ages and almost until the 20th century, gout affected mainly the nobility—hence the nicknames "disease of kings," "disease of the rich," and "disease of aristocrats." It was associated with excess weight and overeating meat. In 1739, the Frenchman Eugène Mouchron published a pamphlet "On the Noble Gout and the Virtues That Accompany It"; in 1927, Havelock Ellis in "A History of English Genius" listed 55 eminent Englishmen who suffered from it.

The first descriptions of gouty arthritis of the big toe date to Ancient Egypt, around 2600 BC. Hippocrates in the 5th century BC noted that women before menopause do not get gout. Leeuwenhoek saw uric acid crystals under the microscope in 1679; elevated blood acid levels were described by Garrod in 1848, and the role of crystals in inflammation by McCarty and Hollander in 1961.

The role of uric acid: how gout develops

Uric acid is a breakdown product of purines, which are present in body tissues and in many foods. It dissolves in the blood, and the kidneys filter it and excrete it in urine. If too much acid is produced or too little is excreted, its level in the blood rises—this is hyperuricemia. By itself it does not equal disease, but in some people the acid forms needle-shaped crystals: they are deposited in joints, causing inflammation and pain, and can cause kidney stones.

There is a similar calcium pyrophosphate arthritis, or pseudogout: the symptoms are the same, but the cause is deposition of calcium pyrophosphate rather than urates.

Who is more likely to get gout and what are the risk factors

Men are affected more often, especially with age: the male-to-female ratio in various data ranges from 7:1 to 19:1. The peak in men is 40–50 years, in women 60 years and older; before menopause women rarely get gout, which is linked to the influence of estrogens. Hyperuricemia is detected in 4–12% of the population; in the US and Europe about 2% of residents have gout, and among men aged 55–65 it is 4–6%.

• excess weight and alcohol, especially beer;
• menopause and use of certain medications, such as diuretics;
• high cholesterol, high blood pressure, kidney disease, osteoarthritis, diabetes, heart failure;
• a previous surgery or joint injury;
• a family history of gout.

A trigger for an attack can be an illness with a high fever, a heavy meal, dehydration, or joint injury.

How gout is diagnosed

According to guidelines, the diagnosis is made by a doctor: they ask about symptoms and diet, examine the joint, and order a blood test for uric acid, sometimes a urine test. If the picture is unclear, a sample of fluid is taken from the inflamed joint with a thin needle and examined under a microscope for urate crystals. When even this is impossible, ultrasound or a special CT scan is done. If necessary, the patient is referred to a rheumatologist.

The doctor may ask when the attack began, which joints are affected, and how long the symptoms have been present.

Complications of gout and when to see a rheumatologist

If attacks recur for years without treatment, joint damage develops, dense tophi form under the skin—usually on the ears, fingers, or elbows; kidney stones and chronic arthritis are possible, although the latter is rare.

See a doctor if gout symptoms appear for the first time or the usual treatment does not help. A separate reason is pain and swelling in a joint that worsen, together with a very high fever, chills, nausea, or inability to eat.

Gout by itself is not a reason to call an ambulance. Call 103 or 112 if pain and swelling in a joint worsen and are accompanied by a very high fever, chills, nausea, or inability to eat: this can happen with an infection inside the joint.

This material is for reference and does not replace a doctor's consultation: the decision on diagnosis and examination remains with the specialist.

This content is for reference and does not replace a doctor's consultation. Medical disclaimer