Compared to other chronic conditions, gout has a remarkable position in medical, historical and other texts from the Byzantine Empire in the sixth century AD - the age of emperor Justinian. The disease and its treatment is thoroughly described in the medical literature, and an effective and still applied drug for treatment of acute attacks - colchicine - was invented already in the fourth century by Byzantine physicians. The disease was apparently accumulated among Byzantine emperors, and according to one source, Justinian was a patient himself. Also, gout may have been common among the citizens of Constantinople. As gout can be due to lead poisoning, a contributing cause for this accumulation may have been exposure to high levels of lead, originating from water pipes, wine containers and cooking pots used for producing the sweetening grape syrup sapa. Although gout seems to have been a significant, widespread and invalidating disease, its influence on the Byzantine society is uncertain. The position of the disease can be interpreted as an indication that lead poisoning was a common condition, thus contributing to other and possibly more important effects on the population and the society.