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Case number 33: About being a famous European and suffering from gout…..
  1. A Boonen1,
  2. Sj van der Linden2
  1. 1Department of Internal Medicine, Division of Rheumatology, University Hospital Maastricht and Caphri Research Institute, The Netherlands
  2. 2Department of Internal Medicine, Division of Rheumatology, University Hospital Maastricht and Caphri Research Institute, The Netherlands
  1. Correspondence to:
    Dr A Boonen
    aboosint.azm.nl

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The Annals of the Rheumatic Diseases, the official EULAR journal, appreciates the European dimension of rheumatology. One of the people who had an important role in the old continent was Charles V (Ghent, Flanders 1500, + San Yuste, Spain 1558). Although his policy did not always favour a unified Europe, the history of his life and illnesses are closely linked with many European countries.

We can learn about details of his illness and complaints from the letters he wrote to his sister Mary of Hungary, widow of the Hungarian king and governess of the Spanish Netherlands.1 In 1532 he describes in one of these letters how he suffered from “attacks of gout”, for which he was treated at that moment in a spa resort near Regensburg, Germany. He wrote that the attacks started after he had fallen from his horse, and he attributed the gout to his fall. We learn that his doctors put him on a severe diet and prescribed purgatives, bed rest for 5 days, and application of warmth to his legs. In the same letter he asks his sister to send him the model of the chair that was used by a member of the general government of the Netherlands, who was also suffering from gout.

Although the above described complaints very probably were gout, it seems that gout was not the only health problem suffered by the Emperor. Several months later, he was seized by recurring pains in his calves, which caused sleepless nights. His doctors assured him, however, that these pains were not podagra because his foot was not swollen or red and neither was it painful when touched. The pains were so severe that in April 1533 the Emperor was advised by his doctors to have his leg amputated and replaced by a wooden prosthesis. However, he preferred to return to Regensburg for spa treatment and, fortunately, with success. During that period he wrote to his sister about eye problems and asked her to send a letter to Sister Mary de Witte, abbess of Florival, France, to ask her for the prescription for the eye medicine, which had cured the eyes of his sister Eleanor of France some years before. Fortunately, the eyes of the Emperor were cured before the medicinal herbs of the abbess arrived in Regensburg. With our modern knowledge of medicine and rheumatology, in particular, we can only speculate on some possible diagnoses….

Anyway, it is confirmed that in later years also, Charles V suffered regularly from “gout”, which caused a lot of pain and hindered increasingly not only his mobility but also his ability to write. The last major turning point in his life occurred in 1550, after he had an accident with his sedan and lost almost all his teeth (fig 1). From that time onward, he had to swallow his food with large quantities of Rhine wine or beer. Surely, this cannot have been beneficial for the gout attacks! After his abdication, the Emperor retired to Spain where he died in 1558, aged only 58 years.

Figure 1

 Etching illustrating the severe prognatia and absence of teeth. The etching is held by the Bibliotheque Municipale, Arras, France.

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