Was Gout Rampant Among the Romans?

Gout in the 21st Century

Towards the end of the last century, a major breakthrough in our understanding of the innate immune system was achieved by the discovery that uric acid crystals could trigger interleukin 1β–mediated inflammation via activation of the NOD-like receptor protein (NLRP3) inflammasome, a multimolecular complex whose activation appears to be central to many pathological inflammatory conditions. But what is uric acid doing in this neighborhood frequented by microbes and other dangerous characters? Why is it serving as a danger signal? Herein lies the last, great riddle of gout that hopefully will be solved sometime soon. In the meantime, shouldn’t the finding of hyperuricemia be enough of a danger signal to alert patients to modify their lifestyles? It may be helpful to have some visual aids to assist you in this task. Consider purchasing a couple of Rodnan prints from the Foundation to cover your spare office walls. They are eye catching and witty—and your gout patients will get the message!

Dr. Helfgott is physician editor of The Rheumatologist and associate professor of medicine in the division of rheumatology, immunology, and allergy at Harvard Medical School in Boston.

References

1. Wu X, Muzny DM, Lee CC, Caskey CT. Two independent mutational events in the loss of urate oxidase during hominoid evolution. J Mol Evol. 1992;34:78-84.
2. Bhattacharjee,S. A brief history of gout. Int J Rheum Dis. 2009;12:61-63.
3. Nriagu, J. Saturnine gout among Roman aristocrats. N Engl J Med. 1983;308:660-663.
4. Nuki, G and Simkin, PA. A concise history of gout and hyperuricemia and their treatment. Arthritis Res Ther. 2006; 8(Suppl 1):S1.
5. The Rodnan Print Collection of the Rheumatology Research Foundation www.rheumatology.org/founda tion/posters/index.asp.
6. Rodnan GP. A gallery of gout. Arthritis Rheum. 1961;4:176-194.
7. Alvarez-Lario B, Macarron-Vicente J. Uric acid and evolution. Rheumatology. 2010;49:2010-2015.