What is gout?
Gout is a disease that results when crystals of uric acid form in tissues of the body. Gout is characterized by an overload of uric acid in the body and recurring attacks of joint inflammation (arthritis). Chronic gout can lead not only arthritis, but hard lumps of uric acid in and around the joints, decreased kidney function, and kidney stones.
What causes Gout?
Uric acid is generated as we metabolize the food we eat and as the body's tissues are broken down during normal cell turnover. Some people with gout generate too much uric acid (10% of those affected) and are medically referred to as "over-producers." Other people with gout do not effectively eliminate their uric acid into the urine (90%) and are medically referred to as under-excrete. Genetics (our inherited genes), gender, and nutrition (alcoholism, obesity) play key roles in the development of gout. Gout is not contagious.
Gout Symptoms and Signs
The first symptom of gouty arthritis is typically the sudden onset of a hot, red, swollen joint. The most common joint involved is at the base of the big toe where swelling can be associated with severe tenderness, but almost any joint can be involved (for example, knee, ankle, and small joints of the hands). In some people, the acute pain is so intense that even a bed sheet on the toe causes severe pain. Acute gouty arthritis at the base of the big toe is referred to as podagra.
Even without treatment, the first attacks stop spontaneously after one to two weeks. While the pain and swelling completely go away, gouty arthritis commonly returns in the same joint or in another joint.
When to Seek Medical Care
Anyone who has a sudden onset of a hot, red, swollen joint should seek medical care, either with a primary-care physician, at an emergency department, or with a rheumatologist (arthritis specialist). These symptoms can also be due to an infection, loss of cartilage in the joint, or other reasons. It is important to make an accurate diagnosis of gouty arthritis as the treatment ultimately is guided by the cause of the inflammation.
Gout Treatment
Self-Care at Home
•Take medications as prescribed.
•While a joint is hot and swollen, you may want to use a cane or similar support to keep your weight off that joint.
•It may be helpful to keep the swollen joint elevated above your chest as much as possible.
•Ice packs can be helpful in relieving pain and reducing inflammation.
•Maintaining adequate hydration is key for minimizing the frequency and intensity of attacks.
•Cherry juice may decrease the intensity and severity of attacks.
Gout Medications
Medicine treatment for gout may be done in two separate stages.
First, the pain, swelling, redness, and warmth (inflammation) during an attack of gout is treated until the symptoms have gone away.
Second, after the inflammation has subsided, other medicines may be used to reduce the uric acid level in the blood and reduce the frequency of future attacks. Most doctors do not start these medicines until several days to weeks after a gout attack is over.
Medicines to lower uric acid levels are not given until a gout attack is over. Starting these medicines during a gout attack can cause movement of uric acid stored elsewhere in the body, which can make the gout attack worse.
Long-term medicine treatment depends on how high your uric acid levels are and how likely other gout attacks are. In general, the higher the uric acid levels and the more frequent the attacks, the more likely it is that long-term medicine treatment will help.
During a gout attack
You may already be taking a medicine to lower uric acid levels in the blood at the time of an attack. If so, you should continue taking your medicine, even during an attack.
If you have been prescribed a medicine to lower uric acid levels (probenecid or allopurinol) and have not been taking the medicine, it is more likely that another gout attack will occur. Do not start taking the medicine during an attack. Medicines that control the uric acid levels in your blood can also make the uric acids stored elsewhere in the body move into your bloodstream. Starting these medicines while you are having a gout attack can make your attack much worse.
Medication
Medicine treatment for gout usually involves some combination of:
Short-term treatment, using medicines that relieve pain and reduce inflammation during an acute attack or prevent a recurrence of an acute attack. These medicines may include:
Nonsteroidal anti-inflammatory drugs (NSAIDs), except for aspirin, which should never be used to relieve pain during a gout attack. Aspirin may change uric acid levels in the blood and may make the attack worse.
Colchicine, which may also be used for long-term treatment.
Corticosteroids, which may be given in pills or by a shot for cases of gout that do not respond to NSAIDs or colchicines. They may also be given to people who cannot take NSAIDs for other reasons, such as those with chronic kidney failure, heart failure, gastrointestinal bleeding or those using a blood-thinner, such as warfarin.
Long-term treatment, using medicines to lower uric acid levels in the blood, which can reduce the frequency and severity of gout attacks in the future. This may include:
Uricosuric agents, to increase elimination of uric acid by the kidneys.
Xanthine oxidase inhibitors, to decrease production of uric acid by the body.
Colchicine, to prevent flare-ups during the first months that you are taking medicines that lower uric acid.
Nutritional value in cherries
Wonderfully delicious, cherry fruit is packed with full of health-benefiting nutrients and unique antioxidants. Cherries are native to Eastern Europe and Asia Minor regions.
Botanically, the fruit is a “drupe” (stone fruit), belonging to the broad rosaceae family of small tree fruits in the genus, prunus. Some of common “drupe” family fruits are plums, peaches, apricots etc. Although several species of cherries exist, two popular cultivars are wild or sweet cherry and sour or tart cherry. While wild or sweet cherry belongs to the species; prunus avium, tart cherry belongs to that of prunus cerasus.
Health benefits of cherry fruit
■Cherries are one of the very low calorie fruits; yet are rich source of nutrients, vitamins, and minerals. Both sweet as well as tart Cherries are packed with numerous health benefiting compounds that are essential for wellbeing.
■Cherries are pigment rich fruits. These pigments are in fact polyphenolic flavonoid compounds known as anthocyanin glycosides. Anthocyanins are red, purple or blue pigments found in many fruits and vegetables, especially concentrated in their skin, known to have powerful anti-oxidant properties.
■Scientific studies have shown that anthocyanins in the cherries are found to act like anti-inflammatory agents by blocking the actions of cycloxygenase-1 and 2 enzymes. Thus consumption of cherries has potential health effects against chronic painful episodes such as gout arthritis, fibromyalgia (painful muscle condition) and sports injuries.
■Research studies also suggest that tart cherries are help body to fight against cancers, aging and neurological diseases and pre-diabetes.
■Cherry fruits are very rich in stable anti-oxidant melatonin. Melatonin can cross the blood-brain barrier easily and produces soothing effects on the brain neurons, calming down nervous system irritability, which helps relieve neurosis, insomnia and headache conditions.
■They are also good source of minerals such as potassium, iron, zinc, copper and manganese. Potassium is a heart-healthy mineral; an important component of cell and body fluids that regulate heart rate and blood pressure.
■The fruits, especially tart cherries are exceptionally rich in many health promoting flavonoid poly phenolic anti-oxidants such as lutein, zeaxanthin and beta carotene. These compounds act as protective scavengers against harmful free radicals and reactive oxygen species (ROS) that play a role in aging, cancers and various disease processes.
■Anti-inflammatory property of cherries has been found effective in reducing heart disease risk factors by scavenging action against free radicals.
■Acerola or West Indian cherry has exceptionally very high levels of vitamin-C (1677.6 mg per 100 g or 2796 % of RDA) and vitamin-A (767 IU per 100 g).
New Research -How eating cherries lowers risk of gout attack
A new study found that patients with gout who consumed cherries over a two-day period showed a 35% lower risk of gout attacks compared to those who did not eat the fruit. Findings from this case-crossover study published in Arthritis & Rheumatism, a journal of the American College of Rheumatology (ACR), also suggest that risk of gout flares was 75% lower when cherry intake was combined with the uric-acid reducing drug, allopurinol, than in periods without exposure to cherries or treatment.
Previous research reports that 8.3 million adults in the U.S. suffer with gout, an inflammatory arthritis triggered by a crystallization of uric acid within the joints that causes excruciating pain and swelling. While there are many treatment options available, gout patients continue to be burdened by recurrent gout attacks, prompting patients and investigators to seek other preventive options such as cherries. Prior studies suggest that cherry products have urate-lowering effects and anti-inflammatory properties, and thus may have the potential to reduce gout pain. However, no study has yet to assess whether cherry consumption could lower risk of gout attacks.
For the present study, lead author Dr. Yuqing Zhang, Professor of Medicine and Public Health at Boston University and colleagues recruited 633 gout patients who were followed online for one year. Participants were asked about the date of gout onset, symptoms, medications and risk factors, including cherry and cherry extract intake in the two days prior to the gout attack. A cherry serving was one half cup or 10 to 12 cherries.
Participants had a mean age of 54 years, with 88% being white and 78% of subjects were male. Of those subjects with some form of cherry intake, 35% ate fresh cherries, 2% ingested cherry extract, and 5% consumed both fresh cherry fruit and cherry extract. Researchers documented 1,247 gout attacks during the one-year follow-up period, with 92% occurring in the joint at the base of the big toe.
“Our findings indicate that consuming cherries or cherry extract lowers the risk of gout attack,” said Dr. Zhang. “The gout flare risk continued to decrease with increasing cherry consumption, up to three servings over two days.” The authors found that further cherry intake did not provide any additional benefit. However, the protective effect of cherry intake persisted after taking into account patients’ sex, body mass (obesity), purine intake, along with use of alcohol, diuretics and anti-gout medications.
In their editorial, also published in Arthritis & Rheumatism, Dr. Allan Gelber from Johns Hopkins University School of Medicine in Baltimore, Md. and Dr. Daniel Solomon from Brigham and Women’s Hospital and Harvard University Medical School in Boston, Mass. highlight the importance of the study by Zhang et al. as it focuses on dietary intake and risk of recurrent gout attacks. While the current findings are promising, Gelber and Solomon “would not advise that patients who suffer from gout attacks abandon standard therapies.” Both the editorial and study authors concur that randomized clinical trials are necessary to confirm that consumption of cherry products could prevent gout attacks
(Source-Arthritis & Rheumatism, a journal of the American College of Rheumatology (ACR)
