title: The 'gout' of the Medici, Grand Dukes of Florence: a palaeopathological study.
abstract: OBJECTIVE
  According to the written sources several members of the famous Medici family of Renaissance Florence suffered from an arthritic disease, called 'gout' by contemporary physicians; a palaeopathological study allowed verification of the true nature of the 'gout of the Medici' referred by archive document data.
  
  
  METHODS
  The skeletal remains of the Grand Dukes and their families, buried in the Basilica of San Lorenzo in Florence, were examined macroscopically and submitted to X-ray investigation.
  
  
  RESULTS
  Out of 15 investigated individuals, two cases of diffuse idiopathic skeletal hyperostosis (DISH), with ossification of the anterior longitudinal ligament and massive hyperostotic changes of the extra-spinal ligaments, were detected in the skeletons of the Grand Dukes Cosimo I (1519-74) and his son Ferdinand I (1549-1609). The left foot of Ferdinand also revealed typical lesions of the uratic gout, confirming the archive data, which describe the disease in detail.
  
  
  CONCLUSIONS
  The association between DISH and elite status, highlighted in recent research, receives further confirmation in the present study, furnishing evidence to the significance of this disorder as a lifestyle indicator, linked specifically with a high-caloric diet, consequent obesity and type II diabetes mellitus. Furthermore, the coexistence between DISH and gout observed in Ferdinand represents the first documentation of this association in the palaeopathological literature.
authors.affiliation: Department of Oncology, Division of Palaeopathology, University of Pisa, Pisa, Italy. g.fornaciari@med.unipi.it
authors.forename: Gino
authors.initials: G
authors.lastname: Fornaciari
authors.forename: Valentina
authors.initials: V
authors.lastname: Giuffra
authors.forename: Sara
authors.initials: S
authors.lastname: Giusiani
authors.forename: Antonio
authors.initials: A
authors.lastname: Fornaciari
authors.forename: Natale
authors.initials: N
authors.lastname: Villari
authors.forename: Angelica
authors.initials: A
authors.lastname: Vitiello
mesh_terms: D001842:Bone and Bones / Q000000981:diagnostic imaging; D006073:Gout / Q000000981:diagnostic imaging / Q000266:history*; D049669:History, 16th Century; D049670:History, 17th Century; D006801:Humans; D004057:Hyperostosis, Diffuse Idiopathic Skeletal / Q000000981:diagnostic imaging / Q000266:history*; D007558:Italy; D017846:Longitudinal Ligaments / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D010164:Paleopathology / Q000379:methods; D011859:Radiography