Who is credited with the early descriptions of gout?
5th century BCE—although gout was reported in medieval medicine as gutta , Latin for “a drop” of a poisonous noxa, Hippocrates first described the clinical features of gouty arthritis (“the unwalkable disease”) following dietary excesses in sexually active men and postmenopausal women.
- Late 1600s—Thomas Sydenham described the clinical features, and Anton van Leeuwenhoek described the microscopic appearance of uric acid recovered from a tophus.
- 1703—Treaty of Metheun. England signed an accord with Portugal to export wool in exchange for importing Portuguese wines. These wines were fortified with brandy and stored in lead casks for shipping. Lead levels were 3 to 19x increased leading to saturnine gout in England.
- 1797—WH Woolaston, an English chemist, demonstrated that urate is the chemical compound that makes up a tophus. He took samples for analysis from tophi on his own ear.
- 1814—John Want reported the effectiveness of colchicine in the treatment of 40 patients with gout. Colchicine had been used by others since the CE 6th century but felt to be too toxic by many because it was a strong purgative/laxative.
- 1857—A.B. Garrod developed an assay (“thread test”) that detected uric acid in synovial fluid in patients with acute gouty arthritis. He also demonstrated uric acid on the cartilage of those with gout and formulated the current hypotheses that lead to gouty arthritis.
- 1961—Joseph Hollander and Daniel McCarty demonstrated monosodium urate in the synovial fluid cells of those with gout using compensated polarized light.
- 1964—Michael Lesch, as a medical student, wrote the clinical description of a patient with neurobehavioral changes for his mentor, William Nyhan, who described the complete deficiency of hypoxanthine-guanine phosphoribosyl transferase, the enzyme that catalyzes the salvage reactions of purines (Lesch–Nyhan syndrome).
- 1950s–present—development of medications for therapy: probenecid (1951), allopurinol (1963), febuxostat (2008), pegloticase (2010), and lesinurad (2015).