Patients with polycythemia vera are more likely to have gouty arthritis. The herb was formerly regarded almost as a specific in gouty and rheumatic affections. She found it was effective for treating acute gouty arthritis and recommended further trials. Use of azathioprine as an alternative has shown to reduce the incidence of gouty arthritis. When Poirot tripped deliberately, he bumped Grant's "gouty" foot, but Grant did not notice. Theophilus captured "a gouty old man, too feeble to flee, and an old woman". Piero the Gouty (b. 1416) and Giovanni de' Medici (b. 1421). Penelope finished the race in second, ahead of a sister to Gouty. Piero the Gouty was the eldest son of Cosimo. Gouty arthritis may be present in up to 20% of patients.