Gout and other stories . . .

BMJ 2014; 348 doi: https://doi.org/10.1136/bmj.g4134 (Published 25 June 2014) Cite this as: BMJ 2014;348:g4134

Gout was the favourite disease of doctors in the ancient world. In Galen’s Rome, most of his wealthy clients ate food flavoured with bird droppings and wine laced with lead salts: rich pickings. But it remains a mystery why humans, alone among mammals (except for a few species of primate), have evolved to lack uricase and, moreover, possess kidneys that retain 90% of the uric acid that passes through them. There has to be some kind of evolutionary survival advantage, although a review of the subject in Rheumatology (2010;49:2010-5, doi:10.1093/rheumatology/keq204) makes it clear that we don’t know what that advantage is. If early humans and the relevant species of primate had smoked, it would be easier to understand. A new study (Thorax 2014, doi:10.1136/thoraxjnl-2014-205271), based on the Health Improvement Network primary care research database, shows that low levels of serum uric acid are associated with higher rates of chronic obstructive pulmonary disease and lung cancer in current smokers after accounting for conventional risk …

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