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Five aphorisms of Hippocrates on gout
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First identified by the Egyptians in 2640 BC, podagra (acute gout occurring in the first metatarsophalangeal joint) was later recognized by Hippocrates in the fifth century BC, who referred to it as 'the unwalkable disease'. The term is derived from the Latin word gutta (or 'drop'), and referred to the prevailing medieval belief that an excess of o...
Context in source publication
Context 1
... identified by the Egyptians in 2640 BC [1], podagra (acute gout occurring in the first metatarsophalangeal joint) was later recognized by Hippocrates in the fifth century BC, who referred to it as 'the unwalkable disease'. Some of Hippocrates' remarkable clinical perceptions in relation to gout are preserved in aphorisms, which are as true today as they were 2500 years ago (Table 1) [2]. Hippocrates also noted the link between the disease and an intemperate lifestyle, referring to podagra as an 'arthritis of the rich', as opposed to rheumatism, an arthritis of the poor. ...
Citations
... Gout is one of the oldest disease concepts. First identified by the Egyptians in 2640 BC, "podagra", or gout, was later recognized by Hippocrates in the fifth century BC [10]. He reported that the risk factors of gout are being male, advanced age, obesity, and alcohol consumption [11]. ...
... He reported that the risk factors of gout are being male, advanced age, obesity, and alcohol consumption [11]. Six centuries later, Galen added heredity as a gout risk [10]. In 1679, Antonie van Leeuwenhoek used his microscope to observe needle-shaped crystals taken from a gouty tophus [10,12], of which the components were later revealed by Wollaston in 1797 to be uric acid [13]. ...
... Six centuries later, Galen added heredity as a gout risk [10]. In 1679, Antonie van Leeuwenhoek used his microscope to observe needle-shaped crystals taken from a gouty tophus [10,12], of which the components were later revealed by Wollaston in 1797 to be uric acid [13]. Garrod showed elevated SU concentration in gout patients in 1848 [14], and hyperuricemia has since been established as the cause of gout. ...
Gout results from elevated serum urate (SU) levels, or hyperuricemia, and is a globally widespread and increasingly burdensome disease. Recent studies have illuminated the pathophysiology of gout/hyperuricemia and its epidemiology, diagnosis, treatment, and complications. The genetic involvement of urate transporters and enzymes is also proven. URAT1, a molecular therapeutic target for gout/hyperuricemia, was initially derived from research into hereditary renal hypouricemia (RHUC). RHUC is often accompanied by complications such as exercise-induced acute kidney injury, which indicates the key physiological role of uric acid. Several studies have also revealed its physiological role as both an anti-oxidant and a pro-oxidant, acting as both a scavenger and a generator of reactive oxygen species (ROSs). These discoveries have prompted research interest in SU and xanthine oxidoreductase (XOR), an enzyme that produces both urate and ROSs, as status or progression biomarkers of chronic kidney disease and cardiovascular disease. The notion of “the lower, the better” is therefore incorrect; a better understanding of uric acid handling and metabolism/transport comes from an awareness that excessively high and low levels both cause problems. We summarize here the current body of evidence, demonstrate that uric acid is much more than a metabolic waste product, and finally propose the novel disease concept of “dysuricemia” on the path toward “normouricemia”, or optimal SU level, to take advantage of the dual roles of uric acid. Our proposal should help to interpret the spectrum from hypouricemia to hyperuricemia/gout as a single disease category.
... Gout is one of the earliest diseases to be documented and was first identified by the Egyptians as early as 2640 BC [2]. Some of the common names of gout throughout the years include "The Disease of Kings" and "The Unwalkable Disease" by Hippocrates, and eventually, the term "gout" was used by a Dominican monk named Randolphus of Bocking in the 1200s [2]. ...
... Gout is one of the earliest diseases to be documented and was first identified by the Egyptians as early as 2640 BC [2]. Some of the common names of gout throughout the years include "The Disease of Kings" and "The Unwalkable Disease" by Hippocrates, and eventually, the term "gout" was used by a Dominican monk named Randolphus of Bocking in the 1200s [2]. What would become the currently known condition of gout stemmed throughout history from an unexplainable pain in the first metatarsophalangeal (MTP) joint, also known as podagra. ...
Gout treatment has evolved rapidly in recent decades, and various drugs have been designed for acute and chronic management. Three medications used to treat gout include pegloticase, colchicine, and febuxostat. When prescribing these drugs, important factors to consider include pharmacokinetics, pharmacodynamics, population specifics, benefits, and contraindications. Pharmacokinetic considerations of each drug include absorption, distribution, metabolism, and elimination factors. Pharmacodynamics factors are assessed by their potential for toxicity and effects on serum uric acid levels. Additionally, the drug’s targeted population must be considered to avoid unwanted complications in certain pre-existing conditions such as cardiovascular disease or glucose-6-dehydrogenase (G6PD) deficiency. In this paper, we aim to provide
insight into the gout medications, pegloticase, colchicine, and febuxostat. This review will include their pharmacokinetics, pharmacodynamics, population specifics, benefits, and contraindications.
... In 2011, Buckley [6] reported on the long history of gout by synthesizing published paleopathological studies of the disease from various parts of the world. In this review, she suggested that selective pressures could influence the high occurrence of gout among modern and ancient populations in the Pacific, thereby challenging the conventional view of gout purely as a lifestyle disease often linked with affluent groups in European history [7][8][9]. ...
Gout has been part of human history for thousands of years. Skeletal evidence of the disease among past people in Europe is often associated with high-status individuals whose lifestyles comprised risk factors for gout, including increased sedentism and greater access to rich, high-caloric, food. A growing body of evidence, however, has shown that multiple factors other than lifestyle also contribute to gout development. In 2011, Buckley presented a review of modern and pre-modern gout cases in which she proposed that selective pressures may partly underlie the high prevalence of gout in the population history of the Pacific region. In this paper, we provide an update on Buckley’s 2011 review of gout in human history. We also review early life stress as a potential underlying factor to consider for gout development, particularly among small prehistoric communities where opulent lifestyles traditionally associated with gout were unlikely to have occurred.
... Patients have only intermittent or persistent hyperuricemia during asymptomatic periods, and during gout attacks, patients may present with acute gouty arthritis, gout stones, and chronic arthritis with clinical manifestations of renal lesions (Li et al., 2019). The current clinical treatment for hyperuricemia and gout is mainly to reduce the blood uric acid level in the body to prevent joint damage and protect renal function (Nuki and Simkin, 2006). A commonly used drug is allopurinol. ...
The aim of this study was to design a chitosan-coated hollow tin dioxide nanosphere (CS-HSn) for loading febuxostat (FEB) using an adsorption method to obtain a sustained-release system (CS-HSn-FEB) to improve the oral bioavailability of FEB. The morphological characteristics of hollow tin dioxide nanospheres (HSn) and CS-HSn were analyzed by transmission electron microscopy (TEM) and dynamic light scattering (DLS). The hemolysis test and CCK-8 test were used to assess the biosafety of HSn and CS-HSn. Powder X-ray diffraction (PXRD) and differential scanning thermal analysis (DSC) were performed on CS-HSn-FEB to analyze the drug presence status. The dissolution behavior and changes in plasma drug concentration of CS-HSn-FEB were evaluated in vitro and in vivo. Sections of intestinal tissues from SD rats were obtained to observe whether chitosan could increase the distribution of nanoparticles in the intestinal tissues. The results showed that FEB was present in CS-HSn in an amorphous state. Moreover, CS-HSn, with good biosafety, significantly improved the water solubility and oral absorption of FEB, indicating that CS-HSn has great potential to improve the intestinal absorption and oral bioavailability of insoluble drugs.
... Gout may progress through four stages. First stage is asymptomatic hyperuricemia, second stage acute gout, third stage inter-critical gout, and fourth stage is chronic tophaceous gout (Nuki and Simkin, 2006) [17] . Bardin and Richette (2014) [2] reported that there are several factors that contribute gout attack. ...
... Gout may progress through four stages. First stage is asymptomatic hyperuricemia, second stage acute gout, third stage inter-critical gout, and fourth stage is chronic tophaceous gout (Nuki and Simkin, 2006) [17] . Bardin and Richette (2014) [2] reported that there are several factors that contribute gout attack. ...
Increased levels of uric acid in the blood cause gout, a chronic and progressive disease. This causes urate crystals to develop in our joints, which causes inflammation and encourages gout attacks. Gout, a form of arthritis, results in painful, joint stiffness and decrement of joint space. Strengthening of muscles along with the biomechanical correction as much as possible, also maintenance and improving the joint range of motion reducing joint pain, increasing the mobility which are the benefits of physiotherapy. The act of walking may be painful or challenging in some cases of acute or, chronic joint discomfort. There are four stages that gout can go through. Asymptomatic hyperuricemia is the first stage, followed by acute gout, inter-critical gout, and chronic tophaceous gout as the fourth stage. Complex carbohydrate, low protein, low fat (mainly from MUFA and PUFA), high fibre, suitable vitamins, minerals, and adequate hydration intake are recommended for patients who are having gout-related symptoms. On the other hand, physiotherapy is essential in the treatment of gout in addition to diet. In this review article, the effectiveness of diet and physiotherapy in reducing gout-related symptoms is reviewed.
... Diet, as an important determinant of serum uric acid (SUA) levels [8], could have a positive or negative impact on the prevention of HUA [9]. Intake of alcohol, sugary sweetened beverages (SSB) and some purine-rich foods for instance red meat and shellfish triggers the increase of SUA levels [10]. ...
Background
Certain foods and food groups could positively or negatively impact serum uric acid (SUA) levels. However, evidence on the holistic dietary strategy to prevent and control hyperuricemia (HUA) development remains limited.
Objective
The aim of this research work was to explore the association of dietary approaches to stop hypertension (DASH) diet with SUA levels and odds of HUA among Chinese adults.
Methods
This research premise included 66,427 Chinese adults aged 18 and above who were part of the China Adult Chronic Disease and Nutrition Surveillance in 2015. Dietary consumptions were assessed via the household condiment weighing approach and a three-day, 24-hour dietary recall. Total fat, saturated fat, calcium, protein, potassium, cholesterol, magnesium, fiber, and sodium were all adopted to calculate the DASH score (score range, 0–9). The associations of DASH score with SUA levels and odds of HUA were evaluated using multiple linear and logistic regression models, respectively.
Results
We established that a higher DASH score was linked with a lower SUA levels (β = − 0.11; 95% CI: − 0.12, − 0.1; p < 0.001) and odds of HUA (OR = 0.85; 95% CI: 0.83, 0.87; p < 0.001) after adjustment for age, sex, ethnicity, education status, marital status, health behaviours and health factors. The association of the DASH diet with odds of HUA was stronger among men (p-interaction = 0.009), non-Han Chinese (p-interaction< 0.001) as well as rural residents (p-interaction< 0.001).
Conclusions
Our results illustrate that the DASH diet was remarkably negatively with SUA levels and odds of HUA in the Chinese adult population.
... Gout merupakan penyakit peradangan sendi dan termasuk salah satu penyakit metabolik yang dipicu oleh penimbunan kristal monosodium urat (MSU) pada jaringan lunak dan sendi (Nuki & Simkin, 2006 (Meera et al., 2020;Suganya et al., 2021;Lee et al., 2010;Murata et al., 2013;Effendi & Sujono, 2018;Flemmig et al., 2011;Ebadollahi & Arabrahmatipou, 2020;Bader et al., 2014;Pirouzpanah et al., 2009;Kuroda et al, 2017;Spanou et al., 2012). Tanaman ...
Al-Qanun Fi’l Tibb II merupakan buku materia medica karya Ibnu Sina yang terkenal di dunia. Buku tersebut menjelaskan secara rinci mengenai monografi tanaman berkhasiat terhadap organ tubuh, salah satunya terhadap tulang dan sendi. Akan tetapi dalam buku tersebut belum memuat komponen major metabolit sekunder yang diduga berperan penting dalam memberikan efek farmakologis. Penelitian ini ditujukan untuk menginventarisasi tumbuhan yang terdapat di dalam buku Al-Qanun Fi’l Tibb II dan melakukan literatur review terkait kandungan metabolit sekunder yang terdapat dalam tanaman tersebut. Metode penelitian dilakukan dengan literature review melalui studi kepustakaan. Hasil pengambilan data menunjukan terdapat 74 tanaman yang berkhasiat terhadap tulang dan sendi diantaranya memiliki komponen major metabolit sekunder seperti senyawa terpen, flavonoid, alkaloid, tanin, alil isotiosianat, saponin, glikosida, alkohol lemak, asam fenolat, benzofenon, kuinon, sekoiridoid, kumarin, stilbene, anthrone, naftalen, benzaldehida dan asam karboksilat. Terpen merupakan metabolit sekunder yang paling banyak ditemukan dalam tanaman yang berkhasiat terhadap tulang dan sendi. Bioaktivitas yang ditemukan pada tanaman diantaranya antigout, antioksidan, osteoprotektif, antiosteoporosis, antibakteri, antiinflamasi dan analgesik.
... Although the prevalence of hyperuricemia is similar among men (21.2%) and women (21.6%), the prevalence of gout is approximately 3 times higher in men than in women (5.9% and 2% of adults in the United States, respectively); the disparity between sexes lessens after menopause. The overall prevalence of gout increases with age, from 3.3% in adults over the age of 40 years to 9.3% in adults over the age of 70 years Family history may also play a small role [3]. PREVALENCE A 4.1% prevalence of hyperuricaemia was found in a previous study in people older than 75 years. ...
Gout is the most common inflammatory type of arthritis in men affecting 1-2%
of adults in Western countries, with male to female ratio of 3.6:1, but rare in pre-
menopausal women and its incidence and prevalence increases with age. It is
characterized by chronic hyperuricaemia which is defined as serum urate levels
above 6.8 mg/dl (≥ 400µmol/L), the level above which the physiological
saturation threshold is exceeded. Risk factors for gout include high dietary
purine consumption, e.g. various types of meat, seafood and certain vegetables,
ethanol intake, obesity and the use of diuretics and low dose aspirin. Symptoms
of an acute gout attack include pain, inflammation and erythema of the afflicted
joint. The above-mentioned inflammation is caused by the release of various
cytokines, including interleukin-1β (IL-1β). IL-1β is an inflammatory cytokine
that is associated with the leukocytosis and fever that often accompany acute
gouty attacks. All patients with gout should be screened for renal dysfunction
and metabolic bone syndrome. An acute attack of gout is very painful and should
be treated with either joint aspiration with intra-articular glucocorticoid
injection, low dose oral colchicine, oral glucocorticoid, NSAIDs or Cox 2
inhibitors depending on the patient’s co-morbidities. On introducing the urate
lowering therapy, prophylaxis therapy should be considered to prevent any
precipitation of acute attack of gout. The starting of low dose of allopurinol or benzbromarone with slow titration may obviate the use of prophylaxis therapy.
Lifestyle modification is important and should be considered in particular to
tackle factors related to metabolic bone syndrome.
... Gout is one of the oldest known arthritis dating back to 2640 BC when it was first identified by Egyptians. 1 It belongs to the group of crystalline arthropathies. Hippocrates, the Father of Medicine, rightly called it "The unwalkable disease," the treatment of which remains a challenge even today. ...
Gout is a disease that has been pestering humankind for centuries. Hence, gout therapeutics has always been a field of ongoing research. Beginning from colchicine, which was the first drug to come into use, to the latest inflammasome inhibitors and monoclonal antibodies, therapies for gout have evolved remarkably over the years. Although gout‐related research came to a standstill in the late 20th century, the 21st century witnessed a renaissance in gout therapeutics with the advent of new xanthine oxidase inhibitors. Our present armamentarium against gout includes drugs that exploit the newfound knowledge about the various mechanisms involved in the pathogenesis of gout as well as drugs used in other conditions, which are effective in gout as well. Many more drugs that promise better management of gout in the future are in the pipeline.
... MSU deposition is caused by an increase in blood uric acid levels due to insufficient excretion or excessive secretion of uric acid [2]. The incidence and prevalence of gouty arthritis are increasing due to unhealthy lifestyles and/or diets [3]. According to epidemiological studies, the incidence rate of gouty arthritis was 0.59‰-2.89‰ ...
Objective
The purpose of this study was to explore the effects of nanoparticles on gouty arthritis, and to provide evidence for the preclinical application of nanoparticles in gouty arthritis and ideas for nanomedicine improvement for nanoparticle researchers.
Methods
Five databases including the Cochrane Library, PubMed, Scopus, Web of Science, and Embase were searched for eligible studies until April 2022. The quality of the selected studies was assessed by SYRCLE’s risk of bias (RoB) tool, and the random-effects model was used to calculate the overall effect sizes of weighted mean differences (WMD).
Results
Ten studies met the inclusion criteria. Results showed that nanoparticles were effective in reducing uric acid levels (WMD: -4.91; 95% confidence interval (CI): − 5.41 to − 4.41; p < 0.001), but were not better than allopurinol (WMD: -0.20; 95% CI: − 0.42 to 0.02; p = 0.099). It was worth noting that the nanoparticles were safer than allopurinol. Subgroup analyses indicated that nanoparticle encapsulated substance, animal species, nanoparticle dosage, animal quantity, and animal gender were all sources of heterogeneity.
Conclusion
The nanoparticles are safe medications for gouty arthritis which can effectively reduce uric acid levels in rodents. Although the results are still uncertain, it is expected to have certain clinical application value. The nanoparticles may be the preclinical medications for gouty arthritis in the future.
