AJM onlineReviewSaturnine Gout, Redux: A Review
Section snippets
Historical Perspective on the “Moonshine Malady”
The earliest historical records of lead poisoning can be traced back to antiquity. Hernberg4 notes that lead-based compounds may have been used in ancient Egypt to commit murder.4 Unknowingly, Hippocrates, in his Epidemics, may have described the first case of lead toxicity, also known as plumbism:⁎ “The man from the mines; right hypochondrium strained; enlarged spleen; stomach tense…the illness went to the left knee, recurrence; he was completely examined.”5 (Plumbism, from the Latin plumbum,
Lead Toxicology and Contribution to Disease
In addition to moonshine, lead exposure worldwide can be attributed to 6 groups of products, including ceramic glazes, solder, gasoline additives, certain paint products, drinking water systems, and natural remedies.19, 20 Although moonshine consumption adds the risk of alcohol to that of lead, the promotion of gout through lead exposure and toxicity is not likely to differ whether the source is moonshine or other products.
In adults, non-moonshine lead poisoning is usually a result of
Saturnine Gout: Characteristic Features and Clinical Manifestations
In his 1886 description of saturnine gout, Lorimer25 noted certain unique characteristics in patients with lead-associated gouty arthritis compared with patients with gout without plumbism, including signs of lead toxicity, such as anemia and Burton's lines (a bluish line on the gums when lead reacts with sulfur compounds produced by bacteria), and a predilection for certain joints. In Halla and Ball's review,14 the knee was the most commonly affected joint in saturnine gout (83%) (in contrast
Mechanisms of Saturnine Gout: Role of Lead in Renal Insufficiency, Purine Metabolism, and Urate Overproduction
Our understanding of the relationships among chronic lead poisoning, renal disease, and hyperuricemia has advanced considerably over the past 100 years. Hyperuricemia is a consequence of systemic overproduction of uric acid, renal underexcretion of urate, or a combination of both. Much of the literature on lead nephropathy and urate handling implicates lead as contributing both to intrinsic kidney disease and to underexcretion of urate (Table 3), whereas a smaller body of research proposes a
Conclusions
Saturnine gout as a manifestation of lead poisoning originated in antiquity and underwent a resurgence in the 20th century, especially within rural areas of the southeastern and midwestern United States. Today, moonshiners can be found throughout the entire United States. Over the last 2 decades, the emergence of a growing number of homebrewers and their artisanal alcohol beverages has brought with it a renewed concern for lead toxicity.44 Clinicians caring for patients with gout should bear in
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Cited by (17)
Lead poisoning: Clinical and laboratory considerations
2023, Advances in Clinical ChemistryEnvironmental Triggers of Hyperuricemia and Gout
2022, Rheumatic Disease Clinics of North AmericaCitation Excerpt :It has been speculated that Michelangelo suffered from gout, possibly related to chronic exposure to lead-based paints used in his masterpieces such as the Sistine Chapel.4 More recently, the popularity of moonshine in the southeastern United States, made in part by running alcohol through a lead-lined car radiator, led to another gout epidemic related to lead toxicity and plumbism.5 This review will examine modern environmental risk factors in the development of hyperuricemia and gout, some of which have persisted since historical times.
Chronic Lead Intoxication From Eating Wild-Harvested Game
2018, American Journal of MedicineCitation Excerpt :Our patient shows that elevated blood lead levels can potentially result purely from ingestion of meat harvested from game shot with lead-containing bullets: no other lead source could be identified and the lead levels improved significantly simply by changing the type of bullets used by the patient. His gout mainly affected large joints, suggesting saturnine gout.7 Our patient's measuring of meat intake allowed us to determine the approximate amount of lead he was ingesting.
Etiology and Pathogenesis of Hyperuricemia and Gout
2016, Kelley and Firestein's Textbook of Rheumatology: Volumes 1-2, Tenth EditionGout: A review of nonmodifiable and modifiable risk factors
2014, Rheumatic Disease Clinics of North AmericaCitation Excerpt :Less common is moonshine; in addition to its ethanol load, its distillation often leads to lead contamination. Chronic moonshine imbibers are at risk for lead toxicity and concomitant saturnine gout due to lead-induced renal dysfunction, decreased urate excretion, and potentially an increase in urate production.71,72 The associations of other alcoholic beverage, such as liquor and wine, have also been investigated (outlined in Table 5).
Funding: Dr Pillinger is the recipient of an investigator-initiated grant from URL Pharma/Takeda to study the effects of colchicine on cardiac disease in patients with gout.
Conflict of Interest: None.
Authorship: Both authors had access to the data and played a role in writing this manuscript.