Gout

What is gout?

Gout is a common type of inflammatory arthritis. It causes pain, swelling, and redness in one or more joints. It usually happens as a flare, which can last for a week or two and then gets better. The flares often begin in your big toe or a lower limb.

What causes gout?

Gout happens when too much uric acid (urate) builds up in your body over a long time. Uric acid is a waste product your body makes when it breaks down purines. Purines are substances that are in your body's tissues and in many foods.

When your body breaks down old cells or digests foods that contain purine, most of the uric acid that's made dissolves in your blood. Your kidneys filter the uric acid out of your blood, and it leaves your body in your urine (pee).

However, sometimes your body can make too much uric acid or does not remove enough of it. Then the uric acid levels build up in your body, including in your blood. Having too much uric acid in the blood is called hyperuricemia. It does not cause health problems for everyone. But in some people, uric acid forms needle-like crystals. They can form in your joints, which causes gout. The crystals can also cause kidney stones.

Calcium pyrophosphate arthritis, sometimes called pseudogout, is a related disease. It causes similar symptoms and is sometimes confused with gout. But it is caused by a buildup of calcium phosphate, not uric acid.

Who is more likely to develop gout?

Many people develop gout. You are more likely to get it if you:

• Are male.
• Are older; it usually develops in middle age.
• Have obesity.
• Have certain health conditions, such as:
  • Heart failure
  • High blood pressure
  • Metabolic syndrome
  • Chronic kidney disease
  • Conditions that cause your cells to break down more quickly, such as psoriasis or some cancers
  • Rare genetic conditions that lead to increased uric acid
• Have a family history of gout.
• Have an unhealthy diet and eat foods that are rich in purines, such as red meat, organ meats, certain seafoods.
• Drink alcohol.
• Eat and drink lots of foods and beverages that contain fructose (a type of sugar).
• Take certain medicines, such as diuretics (water pills), low-dose aspirin, and some medicines that weaken your immune system.
• Take high amounts of niacin (vitamin B-3).

What are the symptoms of gout?

Gout usually happens in only one joint at a time. It is often found in the big toe, but can also affect other joints, including your other toes, ankle, and knee.

Gout flares often start suddenly at night, and the symptoms in the affected joint often include:

• Intense pain, which may be bad enough to wake you up
• Swelling
• Redness
• Warmth

The flares typically get better within a week or two. In between flares, you usually don't have symptoms. Some people may have flares often, while others may not have another flare for years. But over time, if left untreated, your flares may happen more often and last longer.

And if gout is untreated over long periods of time, you can develop tophi. Tophi are hard, uric acid deposits under the skin. They start out as painless, but over time, they can become painful. They can also cause bone and soft tissue damage and misshapen joints.

How is gout diagnosed?

To find out if you have gout, your health care provider:

• Will take your medical history, which includes asking about your symptoms.
• Will do a physical exam, including examining the affected joint(s).
• May order various tests, such as:
  • A test of a sample of fluid from one of your painful joints. The fluid is examined under a microscope and is checked for uric acid crystals.
  • A uric acid blood or urine test.
  • An ultrasound or special CT scan to look for uric acid crystal buildup in the affected joint and check for other conditions that may be causing the symptoms.

What are the treatments for gout?

There are effective treatments for gout. Which treatment you get will depend on your symptoms and the cause of your gout. The goals of your treatment will be to:

• Reduce the pain from gout flares, by using medicines such as:
  • Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen.
  • Acetaminophen and the anti-inflammatory drug colchicine.
  • Oral or injected corticosteroids.
• Prevent future flares, for example by:
  • Making lifestyle changes such as losing weight, limiting alcohol, and avoiding foods high in purines. If you are taking medicines that can cause high uric acid in the blood, your provider may suggest stopping or changing those medicines.
  • If needed, taking medicines to lower uric acid in the blood.
• Prevent tophi and kidney stones, for example with medicines that lower uric acid in the blood.

With early diagnosis, treatment, and lifestyle changes, gout is one of the most controllable forms of arthritis. Treatment and lifestyle changes may help people avoid gout flares, lessen their symptoms, and sometimes even become gout free.

NIH: National Institute of Arthritis and Musculoskeletal and Skin Diseases

Health Problems in Pregnancy

What are health problems in pregnancy?

A health problem in pregnancy is any disease or condition that could affect your health or the health of your fetus. Some health problems may make it more likely that you will have a high-risk pregnancy. A high-risk pregnancy is one in which you, your fetus, or both are at higher risk for health problems than in a typical pregnancy.

But just because you have health problems, it doesn't mean that you, or your fetus, will have a problem during the pregnancy. Taking care of yourself and getting early and regular prenatal care from a health care provider may help you reduce pregnancy risks from health problems.

What raises my risk for health problems during pregnancy?

Every pregnancy has some risk of problems, but your lifestyle, as well as factors like certain conditions and health issues, can raise that risk, such as:

• A health condition you had before you got pregnant
• A health condition you develop during pregnancy
• A pregnancy with more than one baby
• A health problem that happened during a previous pregnancy and could happen again
• Substance use during pregnancy
• Being over age 35

Any of these can affect your health, the health of your fetus, or both.

Can chronic health conditions cause problems in pregnancy?

Every pregnancy is different. If you have specific risks in one pregnancy, it doesn't mean that you will have them in another. But, if you have a chronic condition, you should talk to your provider about how to minimize your risk before you get pregnant. Once you are pregnant, you may need a health care team to monitor your pregnancy. Some common conditions that can complicate a pregnancy include:

• High blood pressure
• Polycystic ovary syndrome (PCOS)
• Kidney problems
• Autoimmune disorders
• Thyroid disease
• Obesity
• HIV
• Cancer
• Infections

Other conditions that may make pregnancy risky can develop during pregnancy - for example, gestational diabetes and Rh incompatibility.

Can health problems in pregnancy be prevented?

You may be able to lower your risk of certain health problems by making healthy lifestyle changes before you get pregnant. These can include reaching a healthy weight, not smoking, and managing any health conditions.

However, health problems during pregnancy are not always preventable. Some chronic conditions can be treated and controlled, while others aren't treatable and carry a higher risk than usual, even if the health problem is well-managed.

Share your symptoms with your provider for early detection and treatment of health problems. Sometimes, it's hard to know what's normal. Some symptoms, like nausea, back pain, and fatigue, are common during pregnancy, while other symptoms, like vaginal bleeding or a severe or long-lasting headache, can be signs of a problem. Call your provider to let them know if something is bothering or worrying you.

Health Risks of an Inactive Lifestyle

What is an inactive lifestyle?

Being a couch potato. Not exercising. A sedentary or inactive lifestyle. These all mean the same thing: a lifestyle with a lot of sitting and lying down, with very little or no exercise.

People are spending more time doing sedentary activities. During our leisure time, we are often sitting while using a computer or other device, watching TV, or playing video games. Many of our jobs have become more sedentary, with long days sitting at a desk or while commuting. And the way most of us get around involves sitting - in cars, on buses, and on trains.

How does an inactive lifestyle affect your body?

When you have an inactive lifestyle:

• You burn fewer calories. This makes you more likely to gain weight
• You may lose muscle strength and endurance, because you are not using your muscles as much
• Your bones may get weaker and lose some mineral content
• Your metabolism may be affected, and your body may have more trouble breaking down fats and sugars
• Your immune system may not work as well
• You may have poorer blood circulation
• Your body may have more inflammation
• You may develop a hormonal imbalance

What are the health risks of an inactive lifestyle?

Having an inactive lifestyle can increase your risk of developing chronic (long-term) diseases. This is sometimes referred to as "sitting disease". By not getting regular exercise, you raise your risk of:

• Obesity
• Heart diseases, including coronary artery disease and heart attack
• High blood pressure
• High cholesterol
• Stroke
• Metabolic syndrome
• Type 2 diabetes
• Certain cancers, including colon, breast, and uterine cancers
• Osteoporosis and falls
• Increased feelings of depression and anxiety

Having a sedentary lifestyle can also raise your risk of premature death. And the more sedentary you are, the higher your health risks are.

How can I get started with exercise?

If you have been inactive, you may need to start slowly. Your health care provider can help you choose the best type or amount of activity for you based on your fitness level and health. You can keep adding more exercise gradually. The more you can do, the better. But try not to feel overwhelmed and do what you can. Getting some exercise is always better than getting none. Eventually, your goal can be to get the recommended amount of exercise for your age and health.

There are many ways to get exercise; it is important to find the types that are best for you. You can also try to add activity to your life in smaller ways, such as at home and at work.

How can I be more active around the house?

There are some ways you can be active around your house:

• Housework, gardening, and yard work are all physical work. To increase the intensity, you could try doing them at a more vigorous pace.
• Keep moving while you watch TV. Lift hand weights, do some gentle yoga stretches, or pedal an exercise bike.
• Work out at home with a workout video (on your TV or on the internet).
• Go for a walk in your neighborhood. It can be more fun if you walk your dog, walk your kids to school, or walk with a friend.
• Stand up when talking on the phone.
• Get some exercise equipment for your home. Treadmills and elliptical trainers are great, but not everyone has the money or space for one. Less expensive equipment such as yoga balls, exercise mats, stretch bands, and hand weights can help you get a workout at home too.

How can I be more active at work?

Most of us sit when we are working, often in front of a computer. It can be challenging to fit physical activity into your busy workday, but here are some tips to help you get moving:

• Get up from your chair and move around at least once an hour
• Park at the back of the parking lot
• Stand when you are talking on the phone or during a video conference
• Find out whether your company can get you a stand-up or treadmill desk
• Take the stairs instead of the elevator
• Use your break or part of your lunchtime to walk around the building
• Stand up and walk to a colleague's office instead of sending an email
• Have "walking" or standing meetings with co-workers instead of sitting in a conference room

The good news is that it's never too late to change your exercise habits. You can start slowly and find ways to fit more physical activity into your life. Regular exercise has many benefits and may help prevent or control many diseases.

Health Screening

Screenings are tests that look for diseases before you have symptoms. Screening tests can find diseases early, when they're easier to treat. You can get some screenings in your doctor's office. Others need special equipment, so you may need to go to a different office or clinic.

Some conditions that doctors commonly screen for include:

• Breast cancer and cervical cancer in women
• Colorectal cancer
• Diabetes
• High blood pressure
• High cholesterol
• Osteoporosis
• Overweight and obesity
• Prostate cancer in men

Which tests you need depends on your age, your sex, your family history, and whether you have risk factors for certain diseases. After a screening test, ask when you will get the results and whom to talk to about them.

Agency for Healthcare Research and Quality

Heart Diseases

What is heart disease?

Heart disease is a general term that includes many types of heart problems. It's a type of cardiovascular disease, which means heart and blood vessel disease.

Heart disease is the leading cause of death in the United States, but there are ways to prevent and manage many types of heart disease.

What are the types of heart disease?

There are many different types of heart disease. Some you may be born with, called congenital heart disease. Other types develop during your lifetime.

Coronary artery disease (also called coronary heart disease) is the most common type of heart disease. It happens slowly over time when a sticky substance called plaque builds up in the arteries that supply your heart muscle with blood. The plaque narrows or blocks blood flow to the heart muscle and can lead to other heart problems:

• Angina - chest pain from lack of blood flow
• Heart attacks - when part of the heart muscle dies from loss of blood flow
• Heart failure - when your heart can't pump enough blood to meet your body's needs
• Arrhythmia - a problem with the rate or rhythm of your heartbeat

Other types of heart diseases may affect your heart valves or heart muscle (cardiomyopathy).

What causes heart diseases?

The causes of heart disease depend on the type of disease. Some possible causes include lifestyle, genetics, infections, medicines, and other diseases.

Who is more likely to develop heart diseases?

There are many different factors that can make you more likely to develop heart disease. Some of these factors you can change, but others you cannot.

• Age. Your risk of heart disease goes up as you get older.
• Sex. Some factors may affect heart disease risk differently in women than in men.
• Family history and genetics. A family history of early heart disease raises your risk. And research has shown that some genes are linked to a higher risk of certain heart diseases.
• Race/ethnicity. Heart disease is the leading cause of death in most racial and ethnic groups in the United States. However, certain groups have higher risks than others. This includes Black people, White people, and American Indian/Alaska Native people.
• Lifestyle habits. Over time, unhealthy lifestyle habits can raise your risk of heart disease. These can include:
  • Eating a diet high in saturated fats, refined carbohydrates, and salt.
  • Not getting enough physical activity.
  • Drinking too much alcohol.
  • Smoking and exposure to secondhand smoke.
  • Too much stress.
• Having other medical conditions can raise your risk of heart diseases. These conditions include:
  • High blood pressure.
  • High cholesterol levels.
  • Diabetes.
  • Obesity.
  • Autoimmune and inflammatory diseases.
  • Chronic kidney disease.
  • Metabolic syndrome.

What are the symptoms of heart disease?

Your symptoms will depend on the type of heart disease you have. You may not have symptoms at first. In some cases, you may not know you have heart disease until you have a complication such as a heart attack.

How are heart diseases diagnosed?

To find out if you have heart disease, your health care provider will:

• Ask about your medical history, including your symptoms
• Ask about your family health history, including relatives who have had heart disease
• Do a physical exam
• Likely run heart tests and blood tests

In some cases, your provider may refer you to a cardiologist (a doctor who specializes in heart diseases) for tests, diagnosis, and care.

What are the treatments for heart disease?

Treatment plans for heart disease depend on the type of heart disease you have, how serious your symptoms are, and what other health conditions you have. Possible treatments may include:

• Heart-healthy lifestyle changes
• Medicines
• Procedures or surgeries
• Cardiac rehabilitation

Can heart diseases be prevented?

You may be able to lower your risk of certain heart diseases by making heart-healthy lifestyle changes and managing any other medical conditions you have.

NIH: National Heart, Lung, and Blood Institute