title: On the history of gout: paleopathological evidence from the Medici family of Florence.
abstract: OBJECTIVE
  Throughout history, gout has been referred to as the "disease of the kings", and has been clearly associated with the lifestyle of the aristocratic social classes. According to the written sources, several members of the famous Medici family of Florence suffered from an arthritic disease that contemporary physicians called "gout". A paleopathological study carried out on the skeletal remains of some members of the family, exhumed from their tombs in the Church of San Lorenzo in Florence, offered a unique opportunity to directly investigate the evidence of the arthritic diseases affecting this elite group.
  
  
  METHODS
  The skeletal remains of several members of the family were examined macroscopically and submitted to x-ray investigation.
  
  
  RESULTS
  The results of the study allowed us to ascertain that the so-called "gout of the Medici" should be considered the clinical manifestation of three different joint conditions: diffuse idiopathic skeletal hyperostosis, rheumatoid arthritis and uratic gout. In particular, uric acid gout was diagnosed in the Grand Duke Ferdinand I (1549-1609). Recently, a new case of this disease was diagnosed in Anton Francesco Maria (1618-1659), a probable illegitimate member of the family.
  
  
  CONCLUSIONS
  With this new case, uratic gout was observed in 2 out of 9 adult males, leading to suppose that the disease should have been a common health problem within the family. The aetiology of the disease has to be searched in environmental factors, since both historical and paleonutritional studies demonstrated that the diet of this aristocratic court was rich in meat and wine.
authors.affiliation: Dept.of Translational Research and New Technologies in Medicine and Surgery, University of Pisa; and Centre for Anthropological, Paleopathological and Historical Studies, Dept.of Biomedical Sciences, Univ.of Sassari, Italy. v.giuffra@med.unipi.it.
authors.forename: Valentina
authors.initials: V
authors.lastname: Giuffra
authors.affiliation: Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Italy.
authors.forename: Simona
authors.initials: S
authors.lastname: Minozzi
authors.affiliation: Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Italy.
authors.forename: Angelica
authors.initials: A
authors.lastname: Vitiello
authors.affiliation: Dept.of Translational Research and New Technologies in Medicine and Surgery, University of Pisa; and Centre for Anthropological, Paleopathological and Historical Studies, Dept.of Biomedical Sciences, Univ.of Sassari, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Fornaciari
mesh_terms: D000328:Adult; D001172:Arthritis, Rheumatoid / Q000000981:diagnostic imaging / Q000266:history; D004032:Diet / Q000009:adverse effects / Q000266:history*; D006073:Gout / Q000000981:diagnostic imaging / Q000209:etiology / Q000266:history*; D049669:History, 16th Century; D049670:History, 17th Century; D006801:Humans; D004057:Hyperostosis, Diffuse Idiopathic Skeletal / Q000000981:diagnostic imaging / Q000266:history; D007558:Italy; D007596:Joints / Q000000981:diagnostic imaging; D008019:Life Style / Q000266:history*; D008297:Male; D010164:Paleopathology / Q000379:methods; D010375:Pedigree; D012307:Risk Factors