Jonathan Kay, MD


July 30, 2013

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Hello. I am Dr. Jonathan Kay, Professor of Medicine and Director of Clinical Research in the Division of Rheumatology at the University of Massachusetts Medical School and UMass Memorial Medical Center, both in Worcester, Massachusetts. Today I am speaking to you from the 2013 European League Against Rheumatism (EULAR) Congress here in Madrid, Spain. Thank you for joining me.

Before attending the meeting I visited the Museo del Prado, one of the great museums of the world, here in Madrid. I came across an interesting painting by Eduardo Rosales, a Spanish painter of the 19th century, who painted a portrait of King Charles I of Spain, also known as Holy Roman Emperor Charles V, receiving Juan de Austria at the Monasterio de Yuste. This interested me because Charles was seated in the chair with his right leg raised and resting on a pillow.

It turns out that King Charles suffered from the king of diseases and the disease of kings, gouty arthritis. Charles was born in 1500, and at the age of 16, upon the death of his maternal grandfather, King Ferdinand II of Aragon (the same Ferdinand who, with his wife Isabella, supported Columbus in his voyage to America), he inherited the throne. His mother, Queen Joanna the Mad, was made Queen of Aragon, but because of her mental instability, Charles was appointed King.

Early in his reign, the conquistadors Hernán Cortés, who conquered the Aztec Empire around 1520, and Francisco Pizarro, who caused the Incan Empire to fall in the mid-1520s, were sent to South America to enlarge the Spanish empire. Shortly thereafter in 1528, because of his excesses, Charles enjoyed drinking alcohol -- and naturally had a 4-handled mug -- so he developed gouty arthritis. He also enjoyed eating meats and rich foods. In 1530 he became the Holy Roman Emperor after the death of his paternal grandfather, Maximilian II, and inherited the Hapsburg throne.

In addition to suffering from gout, Charles was plagued with epilepsy, but his gout became progressively more active. By 1552, his gout caused him to postpone an attempt to recapture the Flemish city of Metz. He couldn't lead his forces into battle and ultimately told his son, Philip II, to take over. By 1556, his gout had become so severe that he actually abdicated the Spanish throne and retired to a solitary existence at the Monastery of Yuste, where he lived for 2 more years, surrounded by clocks to remind him of the passage of time and the passage of his reign. In 1558 Charles died of malaria in solitary retirement at the monastery.

Charles had a chair constructed with a footrest for himself. It is still on exhibit at this monastery. It points out how a disease such as gout could actually change the course of history. Had Charles been aware of the dietary recommendations which are now part of the American College of Rheumatology guidelines for the prevention of gout, perhaps Metz would have been recaptured and history would have been changed. This and other paintings of Charles are interesting and prompt an interest both in Spanish history and gout.


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