Although today we tend to think about diseases in terms of signs and symptoms, tests and treatments, that hasn’t always been the case. For much of history, diseases carried with them a deeper meaning beyond the pathophysiological processes leading to their development. A diagnosis was as much about the identity and personality of an individual as it was about the disease itself, and this was especially the case for the topic of today’s episode: gout. But before we get into the tangled history of this “monarch among maladies”, we first break down its biology and possible evolutionary origins. Once we have a solid understanding of this crystalline illness, we turn our attention to the changing perceptions of gout over time and why gout was once a welcomed diagnosis, in sharp contrast with so many other diseases. Finally, we take stock of gout around the world today, no easy feat. Tune in for a fascinating deep dive into this incredibly common but often overlooked illness.
| History | Biology |
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| Sontag, Susan. Illness as metaphor and AIDS and its metaphors. Macmillan, 2001. | Dehlin, M., Jacobsson, L. and Roddy, E., 2020. Global epidemiology of gout: prevalence, incidence, treatment patterns and risk factors. Nature Reviews Rheumatology, 16(7), pp.380-390. |
| Álvarez-Lario, Bonifacio, and Jesús Macarrón-Vicente. “Uric acid and evolution.” Rheumatology 49.11 (2010): 2010-2015. | Busso, N. and So, A., 2010. Gout. Mechanisms of inflammation in gout. Arthritis research & therapy, 12(2), pp.1-8. |
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| Brooks, George W., and Ernst Mueller. “Serum urate concentrations among university professors: relation to drive, achievement, and leadership.” Jama 195.6 (1966): 415-418. | Choi, H.K., Mount, D.B. and Reginato, A.M., 2005. Pathogenesis of gout. Annals of internal medicine, 143(7), pp.499-516. |
| Choi, Yea-Jin, et al. “Uric acid induces fat accumulation via generation of endoplasmic reticulum stress and SREBP-1c activation in hepatocytes.” Laboratory investigation 94.10 (2014): 1114-1125. | Chu, Y., Sun, S., Huang, Y., Gao, Q., Xie, X., Wang, P., Li, J., Liang, L., He, X., Jiang, Y. and Wang, M., 2021. Metagenomic analysis revealed the potential role of gut microbiome in gout. npj Biofilms and Microbiomes, 7(1), pp.1-13. |
| Cicerchi, Christina, et al. “Uric acid-dependent inhibition of AMP kinase induces hepatic glucose production in diabetes and starvation: evolutionary implications of the uricase loss in hominids.” The FASEB Journal 28.8 (2014): 3339. | |
| Dehlin, Mats, Lennart Jacobsson, and Edward Roddy. “Global epidemiology of gout: prevalence, incidence, treatment patterns and risk factors.” Nature Reviews Rheumatology 16.7 (2020): 380-390. | |
| Kratzer, James T., et al. “Evolutionary history and metabolic insights of ancient mammalian uricases.” Proceedings of the National Academy of Sciences 111.10 (2014): 3763-3768. | |
| MacKenzie, C. Ronald. “Gout and hyperuricemia: an historical perspective.” Current Treatment Options in Rheumatology 1.2 (2015): 119-130. | |
| Nuki, George, and Peter A. Simkin. “A concise history of gout and hyperuricemia and their treatment.” Arthritis research & therapy 8.1 (2006): 1-5. | |
| Rothschild, Bruce M., Darren Tanke, and Ken Carpenter. “Tyrannosaurs suffered from gout.” Nature 387.6631 (1997): 357-357. | |
| Sofaer, Jeffrey A., and A. E. Emery. “Genes for super-intelligence?.” Journal of medical genetics 18.6 (1981): 410-413. | |
| Tan, Philip K., et al. “Coevolution of URAT1 and uricase during primate evolution: implications for serum urate homeostasis and gout.” Molecular biology and evolution 33.9 (2016): 2193-2200. | |
| Wells, Calvin. “A palaeopathological rarity in a skeleton of Roman date.” Medical History 17.4 (1973): 399-400. |
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