What is Gout?
Gout is a painful condition caused by deposits of excess uric acid, in the form of crystals, in the joints and/or soft tissues of the body. These uric acid crystals can cause inflammatory arthritis characterized by intermittent swelling, redness, heat, pain, and stiffness in the joints.
Uric acid is a normal by-product of the body’s breakdown of purines which are found in many foods, such as anchovies, sardines, scallops, dried beans and peas, asparagus, mushrooms, game meats, beef kidneys, liver, gravy, and more. Normally, uric acid is dissolved in the blood, passed through the kidneys, and eliminated through urine. Hyperuricemia, elevated levels of uric acid in the blood, contributes to the development of gout.
How is Gout Diagnosed?
Symptoms of gout can be vague. Elevated levels of uric acid in the blood (hyperuricemia) does not always cause gout. Persons experiencing an acute gout attack may not have concurrent hyperuricemia, but most will have hyperuricemia at some point during the course of their disease. If gout is suspected, a doctor may insert a needle into an inflamed joint, withdraw a sample of synovial fluid, and examine the sample for uric acid crystals.
Signs and symptoms of gout include:
• presence of uric acid crystals in joint fluid
• more than one attack of acute arthritis
• arthritis that develops in a day, producing a swollen, red, and warm joint
• attack of arthritis in only one joint, often the toe, ankle, or knee.
How is Gout Treated?
Gout can be treated with one or a combination of therapies to ease the pain of acute attacks, prevent future attacks, avoid the formation of tophi (nodules of uric acid crystals formed in the soft tissue) and kidney stones, and prevent disability due to gout. The most common treatments for an acute attack of gout are nonsteroidal anti-inflammatory drugs (NSAIDs) or corticosteroids. NSAIDs reduce the inflammation caused by deposits of monosodium urate crystals, but have no effect on the amount of uric acid in the body.
When NSAIDs or corticosteroids fail to adequately control symptoms, your doctor may prescribe allopurinol or colchicine. Your doctor may recommend avoiding high-purine foods or limiting alcohol consumption. If you are overweight, you doctor may also recommend losing weight. Surgery to remove tophi may be recommended.
Cherry Consumption and Gout Attacks
A recent study published in the journal Arthritis & Rheumatism, reveals that consuming cherries or cherry extract may reduce the risk of gout attacks. Researchers at Boston University host an ongoing internet-based, case-crossover study established in February 2003 to investigate alleged triggers for recurrent gout attacks.
Patients diagnosed with gout (n=633) were recruited and followed online for one year. Data was collected regarding the onset of recurrent gout attacks, signs and symptoms (including pain, swelling, and redness within 24 hours), location of attack, and medications used to treat the attack (ie. colchicine, NSAIDs, oral steroids, or steroid injections in a joint). From 2003 to 2010, researchers documented 1,247 gout attacks.
For the 2-day period prior to each gout attack and for 2-day control periods during the year, participants reported information regarding alcohol use, infections, immunizations, physical activity, geographic location, use of anti-gout medications, dietary factors and purported alternative remedies such as cherry products. Of the 633 participants, approximately one-third (n=224; 35.4%) reported eating fresh cherries, whereas only 15 participants (2.4%) used cherry extract exclusively and 33 participants (5.2%) used both fresh cherries and cherry extract. One serving size of cherries was measured as one half cup or about 10-12 cherries.
In analyzing the data, researchers found that eating fresh cherries over a 2-day period was associated with a 35% lower risk of gout attacks compared with no cherry intake. Benefit peaked at 3 servings of cherries consumed over the 2-day period with an associated 61% lower risk of gout attack. Using cherry extract alone showed a 45% lower risk. Allopurinol used alone showed a 53% reduced risk of gout attack, but when combined with cherry intake the risk was reduced 75% as compared to periods of time without exposure to either product.
Authors point to prior research which shows that cherry consumption reduces levels of uric acid in the blood (Jacob, 2003) and may have the capacity to lower uric acid production (Haidari, 2009). It is known that cherries and cherry extract contain high levels of pigments (anthocyanins) that possess antioxidant and anti-inflammatory properties (Wang 1999; Seeram 2001; Kirakosyan 2009; Kelley 2006; Schlesinger 2010; He 2006). Thus, cherries may also be effective against the series of inflammatory responses triggered by uric acid crystals.
This study was supported by the Arthritis Foundation, American College Rheumatology Research and Education Fund, and National Institutes of Health.
Zhang Y, Neogi T, et al. Cherry Consumption and the Risk of Recurrent Gout Attacks. Arthritis Rheum 2012 Sep 28. doi: 10.1002/art.34677. [Epub ahead of print]
NIAMS (National Institutes of Arthritis and Musculoskeletal and Skin Diseases. Questions and Answers about Gout. Updated April 2012, accessed October 13, 2012.
E-Hand.com: The Electronic Textbook of Hand Surgery. Transformation: Excision of Gouty Tophi (warning: graphic images). Accessed October 13, 2012.