Psoriasis and psoriatic arthropathy, historical aspects: part I.

Psoriasis was probably described no later than the first century AD, and the term was coined in the second century. However, a clear association between descriptions recognizable as psoriasis and articular symptoms began in the 19th century. This review was from the English-language, German, and French literature. The development of the differentiation of psoriatic arthritis from clinically similar symptoms, including relevant serologic and radiologic findings and therapeutics with a focus up to the 1960s and the recognition of the efficacy of methotrexate, is reported.

Gout and hyperuricemia in Japan: perspectives for international research on purines and pyrimidines in man.

One of the best-known disorders in purine metabolism is accumulation of uric acid leading to gout. Gout is a lifestyle disease, which was nicely illustrated in the joint symposium of the Japanese Society of Gout and Nucleic Acid Metabolism and of the Purine and Pyrimidine Society held in February 2011 in Tokyo, Japan. The westernization of the Japanese diet led to an increase in hyperuricemia in Japanese, which subsequently boosted research in this field, as illustrated in this symposium. As a consequence, Japanese nucleotide research also expanded, leading to the development of not only new drugs for treatment of gout, but also for other diseases such as cancer, viral infections, and cardiovascular diseases. The research on inborn errors led to the identification of various genetic polymorphisms affecting drug metabolism, revealing differences between Asians and non-Asians. Such genetic differences may also affect the enzymatic properties of an enzyme or a transporter, necessitating specific inhibitors. This knowledge will help to introduce personalization of treatment. In this symposium, the interaction between various specialties formed an excellent basis for translational research between these specialties but also from the bench to the clinic.

[Medico-historical monuments in Hungary from the times of Matthias Hunyadi]. / Hunyadi Mátyás uralkodásának hazai orvostörténeti emlékei.

Author attempted to collect all available medical data of the period of the reign of Mathias Corvinus (1443-1490) who ruled Hungary for 32 years. First part of this article outlines the general medical history of this era. In the 15th century the flourishing Kingdom of Hungary was inhabited by 3-3.2 million people. Under the rule of King Matthias epidemies were frequent visitors, plague e.g. was registered 11 times, while sudor anglicus once (in 1485). The ca. 120 hospitals of the era were founded mostly in towns and market-towns. At the same time 12 leprosories worked throughout the country. Strikingly many dates and details could be collected concerning medical doctors and surgeons working in Hungary. A list of 69 medical doctors and surgeons (60 physicians and 9 surgeons) of this era known by their names is attached to the article. The second and third part of the treatise is a medical history of King Matthias of his relatives and of his court. We can read here a report on the illnesses and death of Janus Pannonius and of Joannes Vitéz who both played an important role in Hungarian culture. Author's further inquiry is focused on diseases and death of the king. Cause of his death was--according to contemporary sources and our present-day knowledge--a cerebral apoplexy. On 6th April 1490 Matthias died suddenly but not unexpected, since his health had already been deteriorated critically during the previous two years, and he had long been crippled by gout. The king's condition had been worsened probably as an effect of factors caused by visceral form of gout. These factors were cardiovascular and renal damages and hypertension, which resulted the fatal cerebral apoplexy causing the king's sudden death.

[Historical review of gout and hyperuricemia investigations].

Historical development of gout and hyperuricemia investigations was reviewed. Gout has been a recognized disease since the fifth century B.C. In 1683, Sydenham described the detailed clinical features of the disease based on his own condition. Leeuwenhoek (1679) first described crystals in a gouty tophus, which were identified as uric acid by Wollaston (1797). Since uric acid clearance of hyperuricemia was markedly lower than that in normal controls, early investigators considered that the main cause of hyperuricemia was urate underexcretion. However, in the 1940s, studies on uric acid metabolism using isotope tracer techniques demonstrated that a part of hyperuricemia resulted from urate overproduction, which was detected in approximately one-third of all gouty patients. In the 1970s, micropuncture, microinjection and microperfusion methods as well as stop-flow methods demonstrated that uric acid transports in nephron were suspected to consist of four steps, that were glomerular filtration, reabsorption, secretion and postsecretory reabsorption. The majority of filtrated uric acid was almost completely reabsorbed, followed by secretion and postsecretory reabsorption at a proximal site in the tubulus. Each proportion of transports to the glomerular filtration(100%) was estimated approximately 99%, 50% and 40%, respectively. Subsequently, about 10% of the filtrate was excreted in the urine. The authors (1999) suggested that the secretion rate of hyperuricemic patients was significantly lower than that of normal controls but postsecretory reabsorption was not. Therefore, the decrease in the secretion rate was suspected to be the main cause of underexcretion. Dunkan (1960) reported a family demonstrating hyperuricemia associated with severe renal damage that progressed rapidely. Currently, this disease is called familial juvenile hyperuricemic nephropathy (FJHN), and was recently found to be the result of a variation in uromodulin. Enomoto (2002) found a number of urate transporters in the cell surface of the tubulus, among which URAT1 was the most effective in reabsorbing urate from the tubulus lumen to the cells. The urate was released to the blood vessel side by the other transporter OAT. Therefore, URAT1 was suspected to be a cause of underexcretion. As the mechanism underlying overproduction of uric acid, de novo purine nucleotide synthesis has been shown to be increased. In some cases, the increase in de novo synthesis is the result of gene mutation in purine nucleotide synthesis enzymes, such as PRPP synthetase (Sperling, 1973) as well as hypoxanthine guanine phosphoribosylpyrophosphate synthetase (Seegmiller, 1967). However, the mechanism in majority of the overproduction has not yet been clarified and is currently under investigation.

Disease of distinction.

Gout is one of the rare diseases that defines its sufferers by class and culture. It is also one of the first chronic diseases to be clinically described. The Egyptians had identified gout as a distinct disorder by 2640 bce. This paper traces the history of gout from its earliest recorded period down to modern times, with a particular emphasis on the cultural, political, geopolitical, and social aspects. Included is a discussion of its role in the American Revolution. Today, gout is a well-understood clinically managed arthritic disease that excites little comment. This is an entirely modern perspective. For most of human history, gout was a disease of distinction that dominated much of medicine, playing the same role in Rome's third century bce aristocracy it would later play in the aristocracies of 17th and 18th century France and England, when each of these countries dominated the world. Because it was considered a disease of lifestyle until modern times, when genetics began to be understood, gout was associated with rich, high status Caucasian men and their excessive consumption of drink and rich foods. It was virtually unknown in Asia, until Western dietary practices became widespread there. From earliest history, gout has been linked with high IQ and sexual promiscuity, which made it grist for artists and writers, and their social commentary up to the time of Dickens; this is discussed, with examples. Because of its association with the rich, gout also developed a powerful moralistic aspect, particularly during the Christian era when the concept of sin was a cultural fundamental. The loose living and indulgence of the rich and the gout it produced made the disease a parable of Christian ethics. The Italian poet Francesco Petrarch (1304-1374) was one of the first to establish this nuance, and it influenced how gout was seen for centuries. Part of what gave gout its special character was that while it tortured, it rarely killed. Indeed, when death was a frequent visitor to families, it was thought a painful but welcomed prophylactic against diseases that did kill. Even in modern times, gout still favors the rich and powerful. American research conducted in the 1960s found that corporate executives, just like their English gentry, or Roman senatorial predecessors, had higher urate concentrations than their blue-collar employees.

A concise history of gout and hyperuricemia and their treatment.

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 one of the four 'humors'--which in equilibrium were thought to maintain health--would, under certain circumstances, 'drop' or flow into a joint, causing pain and inflammation. Throughout history, gout has been associated with rich foods and excessive alcohol consumption. Because it is clearly associated with a lifestyle that, at least in the past, could only be afforded by the affluent, gout has been referred to as the 'disease of kings'. Although there is evidence that colchicine, an alkaloid derived from the autumn crocus (Colchicum autumnale), was used as a powerful purgative in ancient Greece more than 2000 years ago, its first use as a selective and specific treatment for gout is attributed to the Byzantine Christian physician Alexander of Tralles in the sixth century AD. Uricosuric agents were first used at the end of the 19th century. In the modern era, nonsteroidal anti-inflammatory drugs are usually the drugs of choice for treating acute gout. Perhaps the most important historical advance in the treatment of hyperuricemia was the development of xanthine oxidase inhibitors, which are effective in reducing plasma and urinary urate levels and have been shown to reverse the development of tophaceous deposits.