Although today we tend to think about diseases in terms of signs and symptoms, tests and treatments, that hasn’t always been the case. For much of history, diseases carried with them a deeper meaning beyond the pathophysiological processes leading to their development. A diagnosis was as much about the identity and personality of an individual as it was about the disease itself, and this was especially the case for the topic of today’s episode: gout. But before we get into the tangled history of this “monarch among maladies”, we first break down its biology and possible evolutionary origins. Once we have a solid understanding of this crystalline illness, we turn our attention to the changing perceptions of gout over time and why gout was once a welcomed diagnosis, in sharp contrast with so many other diseases. Finally, we take stock of gout around the world today, no easy feat. Tune in for a fascinating deep dive into this incredibly common but often overlooked illness.