science of us

I Have So Many Questions About Gout

The Favourite. Photo: Element Pictures

Although The Favourite (out today, directed by Yorgos Lanthimos) is officially about the intimate tensions among unwell Queen Anne (ruler of England from 1702 to 1707), her charismatic companion Sarah Churchill, and Sarah’s beautiful, cunning young cousin Abigail Masham, I left the movie thinking mostly about Anne’s gout. (The real-life queen also had the disease.)

Her suffering was at times hard to watch, and it gave me some questions that I’ll attempt to both ask and answer here.

What is gout, and what does a gout attack feel like?
Gout is a type of arthritis, and it’s caused by needle-like crystals of uric acid that have built up in the joints. These buildups cause sudden and excruciating bouts of pain that can last for hours, days, or weeks. The most common attack site is the joint at the base of the big toe (here’s a photo), although gout can also affect ankles, wrists, fingers, elbows, and knees.

Afflicted areas are often described as feeling as if they’re on fire, and attacks are typically accompanied by swelling, redness, warmth, and extreme tenderness. (One illustration depicts gout as a tiny demon biting into the foot.)

What causes gout?
Eating foods high in purines can lead to gout, since purines are the substance that gets broken down into uric acid, the overabundance of which forms the painful crystals. Foods especially high in purines include steak and organ meat (liver, brains, heart, kidneys), as well as goose, mincemeat, sardines, and herring. Other factors associated with gout include obesity, recent rapid weight gain, heavy drinking, diabetes, and high blood pressure. Genetics also play a major factor.

So it was gout that caused Anne’s trouble walking?
I think so. Left untreated, gout attacks become more frequent, joints can become permanently damaged, and overall mobility can be affected.

Was gout also responsible for the lesions on her legs? Although we only saw those for a flash, so I could be mis-remembering.
It’s possible the lesions were related to gout’s signature tophi — or uric acid crystal lumps that can collect beneath the skin.

Why were they putting raw steaks on her legs?
I’m not sure, although raw steaks have historically been used to draw botfly maggots from wounds (not that there was any indication of that having happened to Anne). Steaks have sometimes been used as cold compresses, although it also looks like steak-application is mostly a TV and movie trope. Unresolved.

So gout can kill you?
Gout can’t kill you, but it can lead to insulin resistance, heart attack, and stroke. Uric acid crystals can also cause kidney stones and kidney failure. In real life, Anne died of a stroke at 49.

What were the herbs Abigail was collecting in the forest to treat Anne’s gout?
This is just a guess, but it might have been the flower colchicum autumnale, also known as the autumn crocus, an extract of which (colchicine) is still used to treat gout now.

What other famous people have had gout? Wasn’t it a status disease?Other notable gout sufferers include Henry VIII, Benjamin Franklin, Nostradamus, Isaac Newton, Jim Belushi, and Jared Leto, who developed gout in 2008 after gaining 60 pounds for a role (“I had a wheelchair because it was so painful,” he told the Daily News).

Historically gout has been associated with living a luxurious lifestyle (it was once called “the king’s disease”), since sufferers tended to be able to afford the rich foods that aggravate it. In reality, anyone can be affected.

What about that awful scene where Anne was eating and vomiting cake? Was that related to gout?
Not necessarily, although weight gain in general can contribute to gout progression, and sugary, fructose-sweetened drinks (like soda) are now known to be associated with increased risk levels of developing gout.

Who has gout now?
About 4 percent of Americans currently have gout — about 6 million men and 2 million women.

So it’s more of a men’s disease?
Men get gout more frequently, but women’s susceptibility rises after menopause.

What the hell was up with that scene at the end?
I honestly have no idea.

I Have So Many Questions About Gout