Hektoen International

A Journal of Medical Humanities

From gout to rheumatoid arthritis

Although the English physician William Musgrave described the symptoms of rheumatoid arthritis in his 1715 publication De Arthritide Symptomatica, credit is usually given to the twenty-year-old French physician Augustin Jacob Landré-Beauvais (1772–1840). Working at the Saltpêtrière in Paris, he described a disease somewhat different from gout or degenerative joint disease. It affected the poor more often than the rich, women more than men, involved different joints, and had a different natural history. He called the disease “Goutte Asthénique Primitive” or “Primary Asthenic Gout” (1800).1,2

Unlike gout, osteoarthritis, or ankylosing spondylitis, evidence of rheumatoid arthritis has not been definitely found in ancient skeletons, nor is it mentioned in the Bible or in the works of Shakespeare. Yet cases compatible with rheumatoid may indeed have been described in the Ebers Papyrus and in Ayurveda, perhaps observed by Hippocrates and Aretaeus, by emperor Claudius’ physician Scribonius Largus and by the Byzantines Soranus and Michael Psellus. The Byzantine emperor Monomachus Constantine IX (c. 980–1055) may have suffered from it, perhaps also Mary Queen of Scotts. Clinical descriptions by Thomas Sydenham (1676) have been regarded consistent with rheumatoid arthritis, as have some of the lesions depicted by the great Italian and Dutch master painters.1-3

The name “rheumatoid arthritis” itself was coined by the British rheumatologist Sir Alfred Baring Garrod. In his influential 1859 monograph on gout, he devoted an entire section to “rheumatic gout”, for which he proposes rheumatoid arthritis as the preferred name.4 While regarding gouta disease of great antiquity and probably one of the “earliest diseases which flesh became heir to when men began to participate in the luxuries of life,” he admits that gout and “rheumatism” were doubtlessly confounded with each other by the Greek physicians and that this confusion is likely to have continued for many centuries.

According to Garrod, this confusion also extended to certain diseases “connected with gout,” to sciatica, lumbago, lead poisoning, and even kidney disease and diabetes, the major differences clinical difference being that “the blood in gout is invariably impregnated with uric acid.” He pointed out that undoubtedly rheumatoid arthritis was known to Heberden, Haygarth, Cruveilhier, and Charcot in all of its clinical manifestations, including the classical deformities and the nodules. Among the quaint modalities of treatment recommended at that time, he mentions small quantities of Friedrichshall water, Carlsbad salts, rhubarb or colocynth pills, quinine and cod liver oil, guaiacum or iodine, arsenical preparations, or nux vomica. Some baths, such as Turkish baths, were to be used with great care.

Opinions about the origins of rheumatoid arthritis thus clearly remain divided. Some authorities think it is of relatively new origin; others believe it has existed since ancient times.1 It has also been proposed that it first was a disease of the native populations of North America, and that, like syphilis, it was transmitted by the men of Columbus from the New World to the Old through an unspecified vector.1 The issue remains unresolved. Interestingly, Christopher Columbus during his voyages was himself affected by a severe form of arthritis with systemic manifestations, which however is more likely to have been another illness such as Reiter’s syndrome, sarcoidosis, or Behcet’s syndrome.5


  1. Entezami P, Fox DA, Clapham PJ, Chung KC. Historical Perspective on the Etiology of Rheumatoid Arthritis. Hand Clin 2010;27:1-10.
  2. Buchanan WW. Rheumatoid Arthritis. A link with Columbus. Proc.R.Coll.Phys. Edin. 1993;23:209.
  3. Dequeker J. Arthritis in Flemish paintings (1400-1700). BMJ May 7, 1977;1:1203.
  4. Sir Alfred Baring Garrod. A treatise on Gout and Rheumatic gout (Rheumatoid Arthritis). London: Longmana, Green, and Co; 1876.
  5. Dunea G. The mysterious illness of Christopher Columbus. Hektoen International Moments in History Winter 2023.

GEORGE DUNEA, MD, Editor-in-Chief

Spring 2024



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