Gout: a Brief Historical Review

Gout, as a disease, has attracted attention throughout the period of modern history of mankind, including not only doctors. There are a number of reasons why we can call it a "historic" disease. Gout has been known to mankind since ancient times. Among all the rheumatic diseases, it was one of the first to receive a description and for a long time it was the most commonly known joint disease. However, the real reasons for its occurrence have remained unknown for a long time. The purpose of the study was to generalize historical data about gout and methods of its treatment, reasons for its origin, and the main symptoms. Results and discussion. First identified by the Egyptians in 2640 B.C, podagra (acute gout occurring in the first metatarsophalangeal joint) was later recognized by Hippocrates in the fifth century B.C. The term is derived from the Latin word gutta («drop»), and referred to the prevailing medieval belief that an excess of one of the four «humors», which flow into a joint, causing inflammation and pain. Throughout history, gout has been associated with rich foods and alcohol. In the 1st century B.C. Ancient Roman physician Cornelius Celsus first pointed to the relationship between the development of gout and alcohol abuse and excessive overeating. For centuries, the study of gout was usually limited to a detailed description of its clinical picture. Any new knowledge about the disease for a very long time was missing. "Modern" history of gout dates back to the XVII century and is connected with the name of the British physician Thomas Sydenhem, who suffered from the disease. He made the first classical description of an acute gout attack, and also described her differences from rheumatism. In 1776, the Swedish chemist Carl Wilhelm Scheele isolated a new substance from the specimens of patients with nephrolithiasis, and in 1798 chemist Antoine de Fourcroy determined that it was a component of urine and for the first time used the name "uric acid". The crucial contribution to the study of etiology of gout was made by the physiologist Alfred Garrod, who in 1859 discovered and documented for the first time the fact of hyperuricemia in this disease. In 1898, the chemist, Emile Fischer, was able to prove that purines produced by the use of meat products and alcohol are the main source of uric acid in the human body. In 1899, Freudweiler demonstrated that acute gouty arthritis may be caused by intracurrenal injection of microcrystals of sodium monourate. Data from these experiments was ignored for more than half a century before the publication in 1961 of the article by Daniel McCarthy and Joseph Hollander. In their article, they determined the role of urates in the development of acute gouty arthritis by detecting sodium monourate crystals in the synovial fluid of gout patients using polarization microscopy. During the rest of the XX century research of gout was aimed at studying its etiology, risk factors, pathogenesis, diagnosis and treatment. Conclusion. With more than 4500 years history, gout is among the oldest recognized diseases. During the past 50 years advances in understanding the causes and pathophysiology of hyperuricemia and gout, have led to the development of effective therapies.