“Having psoriasis increases the risk of cardiovascular disease, high blood pressure, diabetes, stroke, obesity, high lipids, anxiety, depression, inflammatory bowel disease, and lung disease,” explains Shari Lipner, MD, PhD, a dermatologist at Weill Cornell Medicine. Dr. Lipner notes that up to a third of patients with psoriasis have psoriatic arthritis, a condition that causes pain and swelling in joints and can result in permanent joint damage. She recommends that anyone who has psoriasis be evaluated for psoriatic arthritis, since earlier diagnosis and treatment of the condition reduce the risk of permanent damage and disability.

Psoriasis 101

There are several types of psoriasis, but the most common is plaque psoriasis. Among the more than 8 million Americans who have psoriasis, an estimated 80 percent have plaque psoriasis.

“Plaque psoriasis is an inflammatory skin disease that causes skin cells to form more quickly than average, resulting in scaly plaques. The plaques can affect any area of skin, but the elbows, knees, back, and scalp are the areas most commonly affected,” says Dr. Lipner.

Psoriasis often looks like a patchy rash. It’s usually itchy, but it can also be painful. Psoriatic skin can become dry, crack, and bleed. Psoriasis can interfere with sleep, increase stress levels, take a toll on your mental health, and diminish your quality of life.

The exact cause of psoriasis is unknown, but it is thought to be an autoimmune disease—a condition in which the immune system mistakenly attacks healthy tissue.

Like other autoimmune conditions, psoriasis tends to go through cycles; symptoms often flare up for a few weeks or months and then subside. Flares can be triggered by a number of things and vary from person to person. Some common triggers include stress, skin injuries (cuts, burns, bug bites), infections, and cold weather. Other suspected triggers include alcohol, certain foods and medications, allergies, and environmental factors.

Treatment Options

“Treatment options include topical medications, light therapy, oral immunosuppressive medications, and biologics. Treatments for psoriasis are individualized, so there is no ‘best’ treatment for all patients,” explains Dr. Lipner.

Topical medications are applied to the skin and are most often used to treat mild to moderate plaque psoriasis. These products come in creams, lotions, gels, ointments, sprays, and shampoos; some are available over the counter, and some require a prescription.

Light therapy involves repeatedly exposing the affected skin to light. There are several types of light therapy, many of which use ultraviolet B light. Light therapy is sometimes used in combination with medications that make the skin more responsive to the light.

Most of the medications for psoriasis that are delivered orally or via injection work by suppressing the immune system. While they are often effective at reducing symptoms of psoriasis, these drugs raise the risk of serious infections and cancer and may have other potentially serious side effects.

Oral medications include apremilast, methotrexate, and cyclosporine.

Biologics are drugs most commonly delivered via injection. They include abatacept (Orencia), adalimumab (Humira), etanercept (Enbrel), guselkumab (Tremfya), risankizumab (Skyrizi), secukinumab (Cosentyx), and ustekinumab (Stelara), among others.

If you think you have psoriasis but have never mentioned it to your dermatologist, it’s time to do so. While your psoriasis may be mild, and it may respond well to over-the-counter products, it’s smart to be evaluated by a dermatologist in case there’s more to your condition that could lead to bigger health problems down the road.

The post Don’t Take Psoriasis Lightly: It May Affect More Than Your Skin appeared first on University Health News.

Once you report joint pain, your doctor can check your range of motion, swelling, and strength in the affected joint(s). The exam, along with a detailed medical history and an assessment of risk factors, will help your doctor determine if further evaluation and testing are needed.

Common causes of joint pain include osteoarthritis (degenerative changes due to wear and tear), autoimmune arthritis (such as rheumatoid arthritis and psoriatic arthritis), and injuries. Once a diagnosis is reached, you and your doctor will develop a treatment plan. For osteoarthritis, the plan may include applying ice or heat, physical therapy, and anti-inflammatory medications. If these aren’t effective, injections of steroids or hylauronic acid may be considered. Weight loss, acupuncture, yoga, and tai chi also may help.

If your doctor suspects rheumatoid or psoriatic arthritis, you’ll be referred to a rheumatologist. Blood tests and MRI imaging can provide more information that will help your doctor determine the cause of your symptoms and create a treatment plan.

But you can’t get an accurate diagnosis without taking that first step—so start by telling your doctor about your joint pain. Pursue a conservative course of treatment if that’s what is recommended, but ask for further evaluation and/or a consult with a specialist if your symptoms don’t respond to treatment within two to four weeks.

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What Causes Scalp Psoriasis?

Psoriasis is not contagious. All psoriasis is an autoimmune disease, which means your body’s defense system – your immune system – mistakenly attacks normal cells of your body causing inflammation. With psoriasis, your immune system attacks skin cells making them grow and shed more rapidly than normal. Normally skin cells get replaced over about one month, but with psoriasis, the process can take only three to four days.

There may be abnormal genes passed down through families that cause psoriasis, and some people will have a family history of the disease. On the other hand, many people have a family history of psoriasis and never develop psoriasis and many others develop psoriasis without having a family history. The cause may be genes that need a trigger to become active. Possible triggers and causes for psoriasis to start include:

• Injury to the skin
• Sunburns
• Physical or emotional stress
• Medication reactions
• Smoking
• Drinking alcohol
• Obesity

Scalp Psoriasis Symptoms

Psoriasis plaques will look powdery, silvery, and shiny. Plaques are dry. ©szefei | Getty Images

Like dandruff, scalp psoriasis causes flaking and itching of your scalp, but scalp psoriasis also causes raised and thickened areas of the scalp and skin around the hairline called plaques. Plaques are covered with crusts of flaking skin that is powdery, silvery, and shiny. The plaques may have unusual colors like red, brown, gray, or purple. Seborrheic dermatitis is another condition that may be confused with scalp psoriasis, but this condition causes yellow crusts that are moist, not dry and flaky like psoriasis.

Symptoms of scalp psoriasis may come and go. When they get better it is called remission. When they get worse it is called a flare. These flares and remissions are unpredictable, which adds to the stress of living with psoriasis. Finally, people with scalp psoriasis are more likely to have two other autoimmune diseases, alopecia and psoriatic arthritis. Alopecia causes hair loss, and psoriatic arthritis causes joint swelling and pain. These symptoms may be added to the burden of scalp psoriasis.

Another common place for psoriasis to appear is on your hairline. ©Sergey Dogadin | Getty Images

Scalp Psoriasis Treatment

Scalp psoriasis can be diagnosed by the signs and symptoms. Although there is no cure for scalp psoriasis, and it is likely to be a lifelong problem, there are many treatment options. Treatments work differently for different people, so you need to work with a dermatologist to find the treatment that works best. Most people will have some relief with some combination of these treatments:

• Over-the-counter scalp psoriasis shampoos and creams are available. There are many products, but according to the National Psoriasis Foundation, there are only two over-the-counter ingredients you should look for that actually work. They are salicylic acid and coal tar.
• For more severe scalp psoriasis, there are prescription strength shampoos and skin creams.
• Prescription drugs that block the immune system may be used.
• For the most difficult cases, injection into the scalp with new drugs called biologics may be helpful when other treatments have been ineffective.
• A medical treatment that may help is regular timed exposure to ultraviolet light, called phototherapy.

Scalp Psoriasis Treatment at Home

Some home treatments that may help include moisturizing the scalp with aloe vera, coconut oil, or olive oil. Plaque inflammation may respond to a paste made of baking soda and water. An anti-inflammatory diet that may help can include fish with healthy omega-3 oils, like mackerel, salmon, and sardines. Other anti-inflammatory foods are olive oil and leafy green vegetables.

Preventing or reducing flares of scalp psoriasis may be possible. For some people foods cause flares, so you can keep a food journal to see if there are foods you can avoid. Basic home care tips from the Cleveland Clinic include:

• Avoid hot water showers. Hot water may irritate your scalp.
• Always use a conditioner or moisturizer after washing your hair.
• Brush or comb your hair gently.
• Don’t wear a hat if you don’t need to. Scalp psoriasis does better when it can breathe.
• Try avoiding common triggers like alcohol, smoking, citrus fruits, gluten, and nightshade vegetables (tomato, potato, and peppers).

Let your doctor know if your treatment plan is not working. Ask for help if you feel anxious, depressed, or hopeless. There are many good options for treating this frustrating and unpredictable condition, so keep working with your doctor to find the best options for you.

For more on skin health, purchase the UCLA School of Medicine Skin Care report. 

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A wrist-worn wearable device has been successful in detecting both the flu and common cold in 31 participants (22.6 percent women) inoculated with H1N1 and 18 participants (31.1 percent women) inoculated with rhinovirus, according to a study published in JAMA Network Open Sept. 29, 2021. Participants were inoculated with diluted intranasal drops. Infection detection and severity prediction models were used to measure data on wearable devices. The models were able to distinguish between infection and noninfection with a 92 percent accuracy for H1N1 and an 88 percent accuracy for rhinovirus. Twenty-four hours prior to symptom onset, the models uncovered mild and moderate infection with 90 percent accuracy for H1N1 and 89 percent accuracy for rhinovirus.

Biologic Therapy Reduces Psoriatic Arthritis Risk

Among people with severe psoriasis, biologic therapy, including TNF inhibitors, IL-12/IL-23 inhibitors, IL-17 inhibitors, and IL-23 inhibitors, were found to reduce the risk of developing psoriatic arthritis over a 10-year follow-up period among people with severe psoriasis, as compared with people who were not undergoing biologic therapy. A biologic is any pharmaceutical drug that is derived from a biological source (such as a vaccine). Researchers used electronic medical record data to evaluate 1,326 Israeli patients with severe psoriasis. The retrospective study was published in Arthritis & Rheumatology, Aug. 23, 2021. To qualify for therapy, people should have had little to no success with two other forms of systemic therapy, such as phototherapy, for example.

Dementia Risk Lowers with Mentally Stimulating Jobs

People in cognitively stimulating jobs may have a lower risk of dementia, according to a recent analysis published in The BMJ, Aug. 18, 2021. Researchers reviewed data on nearly 108,000 people, who were free of dementia and were surveyed about their occupations. During an average follow-up period of nearly 17 years, 1,143 of the participants were diagnosed with dementia. After accounting for educational level and an array of risk factors, the study authors reported that, compared with people in low‑stimulating jobs, those whose occupations were deemed cognitively stimulating were significantly less likely to develop dementia in older age. Cognitively stimulating jobs also were associated with lower levels of blood proteins that may inhibit the formation of new connections between brain cells, the study found.

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Blurry vision can be caused by what ophthalmologists call a “refractive error,” which occurs when the shape of the eye prevents light from focusing directly on the retina. Common refractive errors include nearsightedness, farsightedness, and astigmatism. Another common cause of blurry vision is presbyopia, an age-related vision condition that makes it difficult to read at close distances.

Blurry vision may be caused by a number of eye diseases, such as cataracts, age-related macular degeneration, and glaucoma. Also, blurry vision may be a symptom of diabetic retinopathy (an eye disease caused by diabetes), psoriatic arthritis, a condition called vein occlusion that is caused by high blood pressure, or multiple sclerosis.

Blurry or limited vision that occurs suddenly may be a sign of stroke, especially if it’s accompanied by sudden numbness or weakness on one side of your body, difficulty speaking, confusion, loss of balance, or severe headache—if you have any of these symptoms, call 911 and get to the nearest hospital immediately.

Don’t ignore your blurry vision—make an appointment with an ophthalmologist who can check your vision and conduct a thorough examination of your eye. Even if you don’t notice any changes in your vision, it’s important to get regular eye exams; many eye diseases don’t cause any symptoms in the early stages, but they can be detected during an eye exam. If you do have an eye disease, the sooner it is diagnosed, the sooner you can get treatment that may save your vision or delay the progression of vision loss.

And if you suddenly notice an increase in floaters—small shapes or specks that look like spots, thread-like strands, or squiggly lines floating around in your field of vision—see your eye doctor as soon as possible. More numerous and/or more prominent floaters are sometimes a sign of retinal detachment, which can result in permanent vision loss if it’s not diagnosed and treated.

Before I was diagnosed with coronary artery disease, I started having frequent insomnia. Could this be related to my heart disease?

There is evidence that insomnia (defined as difficulty falling asleep and/or staying asleep) is associated with an increased risk for cardiovascular disease, which includes heart disease and artery disease. Insomnia also has been linked with hypertension and elevated resting heart rate—two conditions that increase the risk of cardiovascular disease. In addition, insomnia has been linked with a higher risk of diabetes and other chronic diseases, as well as mental health conditions such as depression and anxiety.

Women are more likely to have insomnia than men, especially if they are age 60 or older. Insomnia is sometimes linked to a coexisting medical issue, such as chronic pain, gastroesophageal reflux disease, lung disease, or polyuria (the need to urinate frequently). In some conditions, such as depression and anxiety, it is difficult to determine whether insomnia is the cause or the effect, but studies show there is a definite link.

There are many strategies that can help with insomnia, including sticking to a set sleep schedule even on weekends, avoiding a heavy meal, caffeine, alcohol, and exercise for at least three hours before bed, limiting daytime naps to no more than 30 minutes, and getting daily exercise. Also ask your doctor or pharmacist to review any medications you are taking to see if your insomnia could be a side effect.

If your insomnia continues, you may want to talk with your doctor about the possibility of seeing a sleep disorder specialist. He or she can do a thorough evaluation aimed at identifying the cause of your insomnia and suggest strategies or treatments that may help you sleep

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 Types of Arthritis Flares: Osteoarthritis | Rheumatoid Arthritis | Psoriatic Arthritis | Gout

According to the Arthritis Foundation, an arthritis flare is a period of increased disease activity that makes your symptoms worse. If you are taking medications to control your arthritis, they may not work as well during a flare. _[2]

Inflammatory Arthritis Versus Osteoarthritis

Knowing the type of arthritis, you have is the key to recognizing and managing a flare up. _[1,2] Osteoarthritis is the most common type of arthritis. It is caused by wear and tear of the cartilage linings of your joints. Since wear and tear takes time, this type occurs mostly in older people. It may be more common in a joint that you injured at some time. It causes pain, stiffness, and swelling, but not inflammation. _[3]

Inflammatory arthritis may be caused by a disorder of your immune system. Your immune system is your body’s defense system against foreign invaders like germs. If you have an immune system disease called an autoimmune disease, your immune system attacks normal body tissues, including your joints. The symptom of the attack is inflammation of tissue in around your joints. _[3]

Autoimmune inflammatory arthritis affects many joints all over your body at the same time. This is also called inflammatory polyarthritis. This type of arthritis is a long-term disease that is often diagnosed in young adults. Both rheumatoid arthritis and psoriatic arthritis are common types. Inflammation adds symptoms of redness and a feeling of warmth to affected joints along with pain and swelling.  _[3]

Gout is also an inflammatory type of arthritis, but it is not caused by autoimmune disease. It is caused by your body producing too much of a substance called uric acid, or your kidneys not removing enough uric acid from your blood. Normally you make uric acid to break down proteins that you eat. Too much uric acid in your blood acid can leak into your joints and form sharp crystals. When this happens, you have a gout attack with symptoms that include severe pain, warmth, redness, swelling, and stiffness. _[1,2,4]

Osteoarthritis Flare Up

An osteoarthritis flare up is usually caused by overusing or injuring an affected joint. This can happen with repeated movements or activity not interrupted by rest. _[1,2] It can be hard to tell a flare up from worsening of the arthritis that occurs over time. Symptoms may include increased pain, swelling, and stiffness. Less common flare triggers include cold weather and gaining weight. _[2] If you have a fare up, try warm heat to relieve pain and swelling, along with rest and an over-the-counter pain reliever. _[1]

Rheumatoid Arthritis Flare Up

Because rheumatoid arthritis always causes a low level of inflammation, flares are common and sometimes occur without a trigger. _[1,5] Symptoms of a flare may include increased pain, swelling, and stiffness. Because rheumatoid arthritis also affects the rest of your body, you may also have fever, fatigue, and weight loss. _[6]

A common cause of a flare is decreasing your anti-inflammatory medication or missing a dose. _[2] Other triggers include physical or mental stress, changes in the weather, exertion, lack of sleep, or an infection like the flu, an upper respiratory infection, or urinary tract infection. _[1,2,5,6]

A rheumatoid arthritis flare may last hours, days, or weeks. A flare that lasts more than a week should be reported to your doctor. Your doctor may need to add on a mechation like a steroid, or change your current medications. To manage a flare, you should alternate rest with some gentle activity to keep your joints moving. Take your usual anti-inflammatory medicines as prescribed. _[6] A cold compress over a sore joint may reduce pain and swelling. _[1]

Psoriatic Arthritis Flare

Psoriatic arthritis is inflammation that can affect both your joints and your skin. Many people may notice a flare of psoriasis before they get increased joint symptoms. Triggers for a flare may include stress, an injury to the skin, a medication reaction, allergic reaction, a change in diet, drinking alcohol, or smoking, as well as changes in the weather. Bacterial infections, especially a strep throat, are another common trigger. _[2] Like other inflammatory arthritis flares symptoms can include swelling, pain, fever, and fatigue. Home care is similar as rheumatoid arthritis. _[6]

Gout Flare Up

Gout symptoms almost always come as a sudden flare up. The most common trigger is eating too much of a protein food that is high in purines. Purines are molecules in proteins. Foods that trigger gout attacks include shellfish and other seafood, beer, red meat, liver, and foods that contain the sugar fructose. You may be able to avoid a got flare up by avoiding high-purine foods. _[1,2]

Gout flare ups occur suddenly, usually at night. The pain, redness, swelling, and stiffness of a gout attack may often affect your big toe. It can also affect the joints of your arms or legs. Injuring a joint, like stubbing your toe, can trigger an attack. _[4]

A gout attack usually peaks at about 12 hours and gradually gets better. To manage a gout attack, rest your joint. You should also call your doctor, because there are medications especially used to treat a gout attack. You can take an over-the-counter nonsteroidal anti-inflammatory medication (NSAID) and use a cold compress on the effected joint. _[1,4]

How Long Does an Arthritis Flare Last?

The length and severity of an arthritis flare is unpredictable and differs from person to person. Different people may also have different triggers for their flares. The best advice is to listen to your body and become aware of your flare triggers. _[5] It may help to keep a flare diary and work with your doctor to developing a flare management plan. Avoid treating a flare a supplement, unless you talk to your doctor first. _[1] If you are having frequent flares or a severe flare that is not responding to your usual home care, call your doctor. Sometime a flare needs medical treatment to prevent permanent joint damage. _[1,2,5]

Sources

1. Houston Methodist Hospitals, What Makes Arthritis Flare Up? Rheumatoid Arthritis, Osteoarthritis & Gout: What Causes Arthritis Flare-Ups | Houston Methodist On Health
2. Arthritis Foundation, What Triggers an Arthritis Flare? What Triggers an Arthritis Flare? | Arthritis Foundation
3. Hospital for Special Surgery, Inflammatory Arthritis, Inflammatory Arthritis: Rheumatoid & Reactive, Gout & More (hss.edu)
4. Mayo Clinic, Gout, Gout – Symptoms and causes – Mayo Clinic
5. Arthritis Foundation, Understanding Rheumatoid Arthritis Flares, Understanding Rheumatoid Arthritis Flares | Arthritis Foundation
6. Oxford University Hospitals, FAQ about managing a flare – Rheumatology (ouh.nhs.uk)

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Once you report joint pain, your doctor can perform a basic exam that checks your range of motion, swelling, and strength in the affected joint. The exam, along with a detailed history that includes a report of any previous injuries or joint problems, as well as an assessment of risk factors, can lead to a presumptive diagnosis and initial treatment plan. Basic x-rays can also help in determining if there is bony or soft tissue swelling. Based on this information, a diagnosis of injury, osteoarthritis (which is agerelated and due to wear and tear), or autoimmune arthritis (such as rheumatoid arthritis and psoriatic arthritis) usually can be made, and treatment, which may include applying ice or heat, physical therapy, and anti-inflammatory medications, can be recommended.

If conservative therapy doesn’t work, it’s time to see an orthopedist or rheumatologist for further evaluation. Blood tests and MRI imaging can provide more details that can help your doctor determine the cause of your symptoms. Gout, which is a type of arthritis, is very common in older age groups, with autoimmune conditions more common in younger patients.

Sometimes, injections of steroids or hylauronic acid, which is similar to the fluid that lubricates your joints, are given. More recent treatments for joint pain include injections of platelet-rich plasma (the component of blood that is rich in anti-inflammatory mediators) or stem cells, but researchers don’t yet have much information about the long-term effects of these treatments, and they may not be covered by your insurance. In addition, there are many new treatments for autoimmune types of arthritis based upon the type of antibody that mediates the condition.

To sum up, start by telling your doctor about your joint pain, since you need an accurate diagnosis to get appropriate treatment. Pursue a conservative course of treatment if that’s what is recommended, but ask for further evaluation and/or a consult with a specialist if your symptoms don’t improve within two to four weeks.

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While pneumonia isn’t as widespread as the coronavirus, it infects more than a million Americans each year and kills more than 50,000, and it’s a common complication in patients with severe COVID- 19. There is a vaccine that helps prevent one type of pneumonia, but more than 30 percent of Americans over age 65 have never been vaccinated for pneumonia, according to data from the Centers for Disease Control and Prevention.

Preventing Pneumonia

“It’s very important to do all you can to prevent pneumonia and other infectious diseases, such as influenza,” advises Michael Niederman, MD, clinical director of Pulmonary and Critical Care Medicine at Weill Cornell Medicine. “This includes getting the pneumonia vaccine if you’re over age 65 or at high risk due to other factors, as well as getting the flu vaccine.” (See the next section for details on risk factors.)

The pneumonia vaccine is very specific for the most common type, pneumococcal pneumonia, which is caused by bacteria. The flu is the most common cause of viral pneumonia in adults, so the flu vaccine also lowers your risk of pneumonia.

“If you’re at high risk of pneumonia, make sure your vaccinations are up to date; depending on your age, you may need more than one vaccine,” says Dr. Niederman.

For most people ages 65 and older, generally, two vaccines are recommended. The first is PCV13 (Prevnar 13), and the second,which should be received a year later, is PSV23 (Pneumovax23). The decision about which vaccine to get, and if you need both vaccines, is one to be made by discussing the risks and benefits with your doctor.

People at high risk due to other factors may get a vaccine before they reach age 65. If you are at high risk and you have not had the vaccine, ask your doctor or pharmacist if you need to be vaccinated.

Beyond Vaccines

It’s also important to continue all of the prevention efforts you’re taking to reduce your risk of the coronavirus, since these steps will lower the risk of any infection that is spread from person to person.

“Originally, we wanted people to wear masks to prevent them from spreading illness, but now, we also know that if you’re wearing a mask, you have less chance of getting an infection. Even if the mask does not stop 100 percent of droplets that are expelled into the air, it significantly reduces the number of particles and amount of the virus that you’re exposed to, which reduces your risk.”

Other prevention strategies include following a healthy, nutrient-rich dietary pattern and maintaining good control of any other medical conditions you have.

Risk Factors for Pneumonia

As noted previously, being age 65 or older raises your risk of pneumonia. Other risk factors include:

• Having a respiratory disease such as chronic obstructive pulmonary disease (COPD) or asthma
• Having a weakened or suppressed immune system due to medical conditions such as leukemia, lymphoma, and HIV, and autoimmune diseases like rheumatoid arthritis, psoriatic arthritis, and lupus
• Treatment with drugs that suppress the immune system, such as chemotherapy and anti-rejection drugs used for organ transplants
• Diabetes
• Chronic liver or kidney disease

If you have any of these conditions, talk to your doctor or pharmacist about the vaccine protocol that is appropriate for you.

Additional Risk Factors

Your risk of pneumonia increases if you are hospitalized.

“People who are in nursing homes and hospitals often have serious medical problems, so their immune systems are impaired,” explains Dr. Niederman. “And they’re in environments in which they are exposed to different bacteria, so their bodies may not be able to produce an adequate immune defense against those specific bacteria.”

If you’re in the hospital and you’re put on a ventilator, you’re at risk of ventilator- associated pneumonia.

“The ventilator itself raises the risk,” explains Dr. Niederman. “It bypasses some of the body’s natural defense mechanisms, such as coughing, so bacteria can more easily enter the lungs.”

Symptoms and Diagnosis

“A productive cough with discolored or bloody phlegm, shortness of breath, and fever are the most common symptoms of pneumonia,” says Dr. Niederman. “However, if you have these symptoms, a physician cannot always tell if it’s pneumonia or bronchitis, a condition that affects the bronchial tubes in the lungs. An x-ray of the lungs can help. If a shadow can be seen on the x-ray, it indicates that the issue is in the lung rather than just in the bronchial tubes, and the diagnosis is more likely pneumonia.”

Tests can be done to identify the cause of an illness, but Dr. Niederman notes that sometimes, immediate results aren’t available when treatment decisions need to be made.

“We provide treatment for what is most likely and most treatable, usually with antibiotics,” he explains. Your doctor will consider your symptoms as well as what is currently happening in your community. For example, if flu is widespread in your area and you have flu-like symptoms, he or she will conclude that you probably have the flu. Diagnosing the flu early is important, since there are therapies that are most effective if given within 48 hours of symptom onset.

Weighing Your Risks

Are you reluctant to see your doctor even if you’re sick because you’re afraid of getting the coronavirus?

“The risk of getting coronavirus from going to a doctor’s office is lower than the risk of not going if you’re very sick. If your symptoms are severe, you need to be evaluated by a health-care provider,” says Dr. Niederman. “Just make sure you take appropriate precautions, such as wearing a mask, washing your hands frequently, and following social distancing guidelines. Doctors’ offices are prepared for you and are now taking new protective precautions because of concerns about coronavirus.”

You can also ask if you can have a video consultation and “see” your doctor remotely; this method of evaluating patients has become very common in recent months due to COVID-19.

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But gout also can be a painful, chronic health issue for women, especially after menopause.

Gout is the most common type of inflammatory arthritis, and an estimated 8.3 million Americans have this condition, of whom more than 2 million are women.

“Gout can be a serious problem in women, and women should be more aware of it,” says Theodore Fields, MD, a rheumatologist at the Weill Cornell-affiliated Hospital for Special Surgery. “After menopause, women are much more likely to develop gout due to the decrease in estrogen that occurs. It is believed that estrogen helps keep uric acid low by increasing the amounts of uric acid eliminated in the urine.” Women, as well as men, should be alert for the warning signs of gout and seek medical attention if they experience signs of joint inflammation.

But gout awareness is about more than noticing painful joints: Gout is associated with higher risks of heart attack, stroke, and heart disease.

Symptoms and Causes

Dr. Fields notes that gout’s most obvious symptom is usually isolated in the large joint of the big toe, or the “bunion joint,” in particular. But some people feel the stinging pain of gout elsewhere, in their feet or ankles, as well their hands and knees. The pain usually subsides after a couple of days, though some minor pain and stiffness may linger. Gout is caused by a buildup of uric acid that forms urate crystals. “In 90 percent of patients, the crystals build up because their kidneys don’t excrete uric acid normally; in 10 percent of patients, their bodies make too much uric acid,” says Dr. Fields. “Either way, uric acid builds up in the blood and then gets deposited, especially in the joints.” Urate crystals cause the release of inflammatory chemicals called cytokines that can cause pain, swelling, and joint damage.

Links to Other Diseases

When large numbers of urate crystals are found in the urine, they may cause kidney stones. Excess uric acid in your body also may make you more resistant to insulin, increasing the odds that you’ll develop diabetes.

But it is the cardiovascular risk associated with gout that may be the most alarming. “In studies, heart attack appears to be more common in patients with gout,” says Dr. Fields. “It is believed that, as in many inflammatory conditions such as rheumatoid arthritis and psoriatic arthritis, the inflammation in blood vessels caused by urate crystals may predispose you to develop hardening of the arteries. Gout patients also more commonly suffer from hypertension, high cholesterol, and obesity than the general population, which all increase cardiac risks.”

Treatment Options

Gout can’t be cured, but it can be managed fairly easily for some patients. “If a patient has had only one gout attack, we can try dietary changes and weight loss,” says Dr. Fields. “Dietary strategies include limiting alcohol of all types, especially beer, limiting red meat and shellfish, and limiting highfructose corn syrup, which is typically found in soft drinks.” Your body produces uric acid when it breaks down purines, substances in these foods— the more purines, the more uric acid.

Other patients may require medications that may include over-the-counter, nonsteroidal anti-inflammatory drugs (NSAIDs), as well as colchicine, a pain reliever specifically designed to treat gout. Other medications include long-term uric acid-lowering medications, such as allopurinol (Zyloprim) or febuxostat (Uloric).

However, to keep symptoms under control, it’s important for gout patients to become educated about why they need long-term treatment and to commit to the treatment. “The success of long-term treatment of gout is spectacular, but only if people stick to the recommended diet and stay on medication if it’s been prescribed,” says Dr. Fields.

Your primary care physician may be able to handle your gout treatment, but Dr. Fields advises that patients with serious cases consult a rheumatologist. Dr. Fields urges women who have gout symptoms to see a doctor as soon as possible. When gout is diagnosed and treated early, symptoms often can be reduced, and a proactive treatment plan can be developed to prevent future flare-ups.

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The novel coronavirus, which causes the disease COVID-19, has upended normal life for most Americans. The extraordinary measures being taken now by the government are meant to slow down transmission of this new virus. If we act and adhere to recommendations of the Centers for Disease Control and Prevention (CDC), most people will not be infected and become sick. In order to keep the numbers as low as possible and to protect those most vulnerable to serious health consequences and death from the virus, it’s important to take precautions.

According to the Centers for Disease Control and Prevention (CDC), older adults and people with underlying health conditions appear to be the most at risk for serious health problems with the virus. The CDC has a wealth of information on their website (https://www.cdc.gov/coronavirus/2019-ncov/index.html). In addition to avoiding unnecessary contact with other people, washing your hands often, and cleaning frequently touched surfaces every few hours, the CDC also advises keeping a two-week supply of medications, food and other essentials on hand.

Any medication you take for a chronic health condition should not be interrupted if at all possible. For many health conditions, including inflammatory forms of arthritis such as rheumatoid arthritis and psoriatic arthritis, stopping the drugs your doctor has prescribed or taking them less frequently can lead to a flare-up of symptoms.

If you are running out of medications that you take regularly, contact your doctor or pharmacist about getting more. Questions to ask your doctor include:

• Can I get a prescription for a longer period of time, for example, three months? This often will depend on your insurance plan.
• Are some medications more critical than others? Certain medications you take may be more essential than others. For example, it’s more critical to not interrupt a blood pressure medication than a nonsteroidal anti-inflammatory drug (NSAID).

Some pharmacies will deliver medications. If not, you can ask a young, healthy person to pick up your medications. Some pharmacies have a drive-through option. If you cannot get medications from the pharmacy, consider getting them from a mail-order pharmacy. This usually takes several weeks, however.

If you are low on medications, you may be tempted to borrow some from someone else. This is not recommended. Even if the person takes the same medication, it may be a different dose. Errors can occur.

Keep a list of all your medications in an easily accessible place, and make sure a family member or friend knows where it is. Make sure you have contact information for your doctor and pharmacist, as well as local and state public health departments. In case you are unable to reach your doctor or pharmacist or medication supplies are not available, local or state health officials should be able to help you.

Chad Deal, MD, Head of the Center for Osteoporosis and Metabolic Bone Disease at Cleveland Clinic, and Associate Editor of Arthritis Advisor, contributed to this report

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