November 2012

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   The study focused on 633 patients with gout, 35 percent of whom ate fresh cherries, 5 percent of whom consumed both cherry fruit and cherry extract, and 2 percent of whom consumed only cherry extract. Study authors note that a cherry serving equaled one-half cup or approximately 10 to 12 cherries. According to the results of the study, gout flare risk continued to decrease with increasing cherry consumption up to three servings over two days. The study authors note that further cherry intake beyond three servings over two days did not provide additional benefits to the patient. Additionally, they reported the risk of gout flares was 75 percent lower when the patients combined cherry intake with the uric-acid reducing drug allopurinol.

   Nathan Wei, MD, a rheumatologist, sees approximately 30 to 40 patients a month with gout and recommends cherries to his patients.

   “Many patients already are using (cherries) on their own. There is no harm in trying it. I’m not sure of the effectiveness long-term,” explains Dr. Wei, a Fellow of the American College of Physicians and the American College of Rheumatology.

   William Fishco, DPM, FACFAS, does not specifically recommend eating cherries to reduce gout attacks although he notes he may consider it. Patients should reduce high protein foods, particularly red meats, beans and seafood, as well as beer and sugary drinks to decrease their uric acid levels, notes Dr. Fishco, who is in private practice in Anthem, Az.

   “I certainly think more research will be done on cherries or other food products to prevent gout,” adds Dr. Fishco, a faculty member of the Podiatry Institute. “Pharmaceutical companies will be first in line to develop a ‘cherry pill’ as patients (consumers) would feel more comfortable taking a ‘food’ drug versus traditional drugs like allopurinol.”

   Dr. Wei encourages further studies researching cherries and other food products to lower uric acid for patients with gout, noting it may allow patients to take lower doses of medication. He recommends avoiding high-purine foods and increasing the intake of omega-3s from foods such as fish to combat gout attacks.

   “The acute attacks can be managed with either colchicines in low doses, glucocorticoids or non-steroidal anti-inflammatory drugs (NSAIDs),” explains Dr. Wei. “The more difficult problem is long-term treatment of the hyperuricemia. For this, we can use allopurinol, probenecid, febuxostat (Uloric, Takeda Pharmaceuticals) or pegloticase (Krystexxa, Savient Pharmaceuticals) (if patients have severe tophaceous gout).”

How Accurate Is The Probe-To-Bone Test For Osteomyelitis?

By Brian McCurdy, Senior Editor

A recent study in the Journal of the American Podiatric Medical Association assesses how well the probe-to-bone test can detect lower extremity osteomyelitis in patients with diabetes.

   The study focused on 65 patients, 39 of whom had osteomyelitis. The study says probe-to-bone tests were positive in 30 patients. The positive predictive value for the probe-to-bone test was 87 percent but the negative predictive value was 62 percent. The sensitivity and specificity of the test were 66 percent and 84 percent respectively, according to the authors.

   In the big picture, James Wrobel, DPM, sees the probe-to-bone test as a “good, widely available test” for the clinic, although he notes that the effectiveness of the test can vary in different conditions.

   For example, since osteomyelitis is less prevalent under standard outpatient conditions, the positive predictive value is not as good as it may be with infected inpatients in whom osteomyelitis is three times more prevalent, according to Dr. Wrobel, an Associate Professor of Internal Medicine with the University of Michigan Health System.

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