Gout: Not Just for Fictional Characters

No disease, with the possible exceptions of leprosy and the plague, has had quite the impact on literary characters, or literature writers, as gout.

Authors used gout as a literary device to signify the character was living high. The working class didn't get gout; the gentry did. Scenes of patrician decadence were often crafted around descriptions of overstuffed men in overstuffed wing chairs with a foot bandaged and elevated as servants raced to pour them some more port.

Perhaps gout was so popular in literature because it was so prevalent among the writers who wrote it and the great men whose work inspired so much of it.  Benjamin Franklin, Martin Luther, Leonardo da Vinci, Oliver Cromwell, Theodore Roosevelt, Alfred Lord Tennyson, Joseph Conrad, King Henry VIII, Henry James, Thomas Jefferson, Wilkie Collins, Voltaire, Charles Darwin, Sir Isaac Newton, John Milton, Benjamin Disraeli and Galileo are among the famous gout-sufferers of history. It's quite a club!

Gout occurs when urate crystals accumulate in your joint. These crystals gather when you have high levels of uric acid in your blood. Under most circumstances, uric acid dissolves in the blood and passes through your kidneys, leaving your body with your urine. But if your body produces too much uric acid, and/or your kidneys secrete too little, the uric acid accumulates, forming sharp, needle-like urate crystals in a joint or surrounding tissue.

It's also excruciatingly painful.

You produce uric acid in your body when you break down purines, compounds found in foods such as steak, seafood, and organ meats. Alcoholic beverages and sugary drinks – those high in fructose – also contribute to excessive uric acid production.

The “disease of kings” can affect anyone, although older men are its most likely targets. It is characterized by sudden, severe attacks of pain, redness and tenderness in joints, often the joint at the base of the big toe. It often kicks in during the middle of the night, awakening its victim with the sensation that his toe is on fire. The affected appendage will be hot, swollen, and incredibly tender, and the most pain you are likely to ever have experienced. You will not need much encouragement to see a doctor.

Your doctor will likely diagnose your condition by drawing and analyzing fluids from the affected joint. In certain cases, an X-ray or CT scan may be prescribed to rule out other sources of inflammation.

Happily, doctors are better equipped to treat gout today than they were in Ben Franklin's time. Corticosteroids can be used to control pain and inflammation, and the drug colchicine effectively targets gout pain. Probenecid, which improves the kidneys' capability to excrete uric acid from the body, may also be prescribed.