Some great pieces from my international colleagues lately!
Dr. Irwin Lim discusses the role of methotrexate therapy here and here. Thanks, Irwin, for your insights.
Also check out his recent video which helps me explain to patients why allopurinol may actually cause a gout flare.
Finally, let’s travel over to Ireland and check out the many videos by Dr. Ronan Kavanagh. Great work, Ronan! (Irwin I see you’re on clear.md as well – I think I’m going to leave the videos to you guys and I’ll keep to the written word). So pleased to be able to share and collaborate with rheumatologists all over the globe.
Photo: taken at the Highland Games in New Hampshire
Did you know that I write a health blog for the Worcester Telegram and Gazette? The latest one was about patients asking me about cherry juice as a gout treatment. Keep in mind these are short, general purpose blog entries for the newspaper site. Here is a reprint:
Maybe it is because the grocery stores are fully stocked with beautiful cherries this time of year, but several patients in the last few weeks have come in touting the merits of cherries as a gout treatment. Yes, I’d heard this before and no, I didn’t really know why. Some patients eat cherries, some drink the juice and some take special cherry juice extract pills they purchase through a vitamin store. My first reaction to the patient who claimed eating a pound of cherries a day cured his gout was, “wow, you must spend a lot of time in the bathroom!” But I digress . . .
Why cherries? I searched good old google and found mainly advertisements or websites trying to sell juice or extracts. I turned to google scholar and to PubMed, which is an internet database of the US National Library of Medicine and National Institutes of Health, or a site where you can search for what we call “scholarly articles” or scientific research printed in medical journals. I did find some articles talking more specifically about the chemicals in cherries. Some of them were sports-medicine related and discussed cherry juice for post-workout recovery following intense exercise, like marathons. There is an article loaded with very “science-y” words in a journal called Plant Foods for Human Nutrition called “Improved antioxidant and Anti-Inflammatory Potential in Mice Consuming Sour Cherry Juice.” I wonder how well the mice liked the cherry juice?? (According to the article the food pellets incorporated the juice). An article in the Journal of Nutrition was titled “Consumption of Bing Sweet Cherries Lowers Circulating Concentrations of Inflammation Markers in Healthy Men and Women.”
I did skim a few more articles and overall it seems there are some anti-inflammatory chemicals in cherries that may have a benefit in inflammatory conditions, like gout. Bottom line? If your gout isn’t that bad and you find eating cherries or drinking juice daily prevents attacks, great! If you feel cherries can prevent a gout attack when you feel one coming on, also great! Remember that cherries and especially juices have calories and sugar. Overdoing it can lead to weight gain or high blood sugars for diabetics. Also, we’re talking tart cherries, bing cherries or dark sweet cherries. Stay away from the bright red ones in the jar! Remember that uncontrolled gout can lead to a chronic and deforming arthritis, so be sure to discuss your condition and what you’re doing for it with your doctor. It is possible your condition may require a prescription gout medication.
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There are lots of useful sources online to provide more information about gout, such as WebMD or UpToDate for Patients. Based on what my patients ask me in the office, a lot of the patient education information seems to focus on management of diet to control gout. Certainly dehydration can precipitate a gout attack, so remaining hydrated is usually recommended (keeping in mind some patients may be on fluid restriction for other medical conditions). A 2004 article in the NEJM concluded that,
Higher levels of meat and seafood consumption are associated with an increased risk of gout, whereas a higher level of consumption of dairy products is associated with a decreased risk.
Among the medications used to treat and prevent gout is another oldie but goodie, a medication called colchicine. In early December some preliminary emails were circulated with rumors that this inexpensive generic medication was going to be removed from the market and a more expensive brand name medication would take its place. These rumors were confirmed and can be read about in more detail in this article, which appeared in several newspapers. According to the article,
In December, the American College of Rheumatology sent a letter to the FDA seeking to discuss how to keep colchicine affordable. “We want to express our concern that a medicine used for centuries to treat gout and rare conditions, which costs pennies, will now cost patients quite a bit more,” said Dr. Stanley Cohen, a Dallas rheumatologist who is president of the college, in an interview. “That doesn’t make sense in the setting of healthcare reform.”
I’m afraid it doesn’t make much sense to me either. Gout (and Familial Mediterranean Fever, the other condition for which colchicine is commonly used) is not a very fancy disease. No one is wearing gout awareness ribbons. But ask anyone who has suffered a severe gout attack how important it is to him or her to have treatment options. In our current healthcare climate, it seems like affordability of these options would be of particular importance. Wonder why we’re not hearing more about this.