Gout, can it really be gout? I don't drink port! - March 2026

[Music] Welcome back to Coffee Break, the audio equivalent of finally finding shoes that don't make you win. This week we're talking about gals. Yes, it's real, it's common, and no, it's not just a medieval thing. It's a type of arthritis that can strike suddenly, usually in the big toe, but it can hit over the joints too. And it's not just about red wine, port and fancy Jesus, there are loads of mist to glow up. So we'll talk about triggers, treatment, prevention, and why it's nothing to be embarrassed about. All in this episode of Coffee Break. [Music] I'm Dr. Jeff Hampe, and I'm Dr. Sam McGinley. And this is season one of Coffee Break. We are two general practitioners from beautiful dogs that are in the United Kingdom, and we are happy to have you here with us for another Coffee Break. In our show we give you helpful and useful health and wellness information in short and easily digestible episodes. That's right, and hopefully in a fun and enjoyable way as well. In today's Vat Sea of Health information, we hope to be your trusty island of reliable and impartial independent, unbiased information. And we may even have some guests with us to help. So sit back and enjoy. Hey Coffee Break. [Music] Okay, so let's talk about Galt, shall we? Yeah. Across the globe, Galt is the most common type of inflammatory arthritis. And it's really important to get yourself reviewed correctly if you think you have Galt, because appropriate treatment will not only help prevent you from having other horrible joint pain attacks, which anyone who's had it will know it's incredibly painful, but also will contribute to an improvement in your overall health. Yeah. Okay, so why does Galt occur? Well, Galt is caused by too much uric acid in the bloodstream, which is medically known as hyper-uricemia. And an overload of uric acid in the body means painful crystals that are almost like needles aren't they? Yes. Forming in and around the joints and under the skin. Yes. And most people with Galt have high levels of uric acid in their body because it hasn't been efficiently and effectively removed by the kidneys and washed out in the urine. Yeah, indeed. So what actually causes it to happen in the first place? Well, too much uric acid can be caused by, as we said earlier, an issue with the way it's washed out of the system, but also if too much is going in to the body that encourages the uric acid to be produced. So this is in particular a diet rich in what we call purines, which is a type of protein found in many foods. And we'll go over the foods that are high in periods later. Yeah. Yeah. Also alcohol, crash dieting, stress, prolonged illness, injuries and certain medications, particularly diuretics, so water tablets and aspirin. Less commonly, some people will make too much uric acid in the first place and this could be a genetic condition that they've inherited. And Galt is sometimes associated with other diseases and medical conditions. And these are, there's a long list for this, but these include obesity, diabetes, high blood pressure, heart attack, sand, dyno, stroke, so all the cardiovascular diseases, peripheral vascular disease. So that's poor circulation in the limbs, high polypidemia, so high levels of cholesterol and other fats in the blood, kidney disease and also psoriasis. Indeed, yeah. So interestingly, Galt as a condition may present with a joint pain that's actually the origin of something else that's underlying in the body and that's why it's worth getting yourself checked. So let's look at the symptoms of Galt. Well, in fact, any joint can be affected by Galt, but there are some typical areas aren't there that can be affected, which include the toes, particularly the big toe, ankles, knees and fingers. And there are some signs and symptoms to look out for. Yeah, definitely. So signs and symptoms of Galt can include severe pain in one or more joints. The joint often feels quite hot and is very, very tender, really quite painful. It can be painful enough that you might think you've broken it and the joints are more often not swung in and around the affected joint and they're often red and shiny. The skin's often quite tortoise and quite warm and that's why it's important, isn't it, to see it up to because actually these symptoms can also be seen in other conditions which are not gout such as an infection in the joints. Yeah, absolutely. And almost everybody would get well experienced further flares at some point and usually within a year. Absolutely. Yes. So when do the symptoms happen? Well, there are some typical times and presentations, but doesn't fit everybody. So a flare of gout will often occur at night. It's important to develop quickly, usually over a short number of hours. Then the attack itself of the pain, the redness, the swelling that we talked about would last between three and ten days. And as we said, may recur, come back. And if not treated, then the episodes could become more and more frequent. And after a gout flare, the affected joint should return back to normal, but the problem can persist and that is particularly if treatment isn't started over the right time. And that's a good point to talk about complications in gout isn't it, because repeated gout flares can lead to joint pain and deformity in the joint as it starts reaching the attack, the joint itself. And then that's a bit of a vicious cycle, isn't it? Because they use stuff to get other forms of arthritis, right? You can get some people gouty, tow-fi, you know, which you tend to see in really severe episodes of gout, so people have repeated gout. These are where the crystals get deposited under the skin in the swelling itself. These are really very difficult to treat on their own. Really difficult. And mental health impact, you know, trying a long-standing pain, affecting you going out, affecting you walking really has an impact and takes a toll on your mental health wellbeing. Yeah, absolutely. Okay, so let's talk about some tests, shall we? Most commonly, the first thing that happens is if you think you're gout, you'd come to see your clinician, look at the joint, and if we're thinking, yeah, that looks like gout, we're going to aim to confirm that by doing a blood test, and we can actually check your uric acid levels in the bloodstream. Now, there's varying opinions about when this can be taken, specialists might say you can do it straight away, which you could do. Historically, people have waited a short number of weeks before they test it, the reason being that we think, physiologically, that during an attack, the uric acid levels in the bloodstream will be artificially lowered during an attack. Yeah, yeah. Yeah. You may then, if you're going to have some test done, have a few other general health bloods done, so we might be thinking about diabetes, about checking your kidney health and your cholesterol levels and doing a blood pressure as well. If it's a larger joint, you could have your joint aspirated, so a small needle is placed into the swollen joint and some of the liquid removed. Sounds terrifying, doesn't it, but it can be helpful, and certainly if you were in hospital, I'm sure an orthopedic doctor would be delighted to do that. So, you've got a gap to what's the treatment? Well, if you've never had gap before and you think you might have an attack, as I said, get an appointment to have that checkpad as soon as possible, whilst waiting, it's best to call it down. So, try and avoid using the joint as much as possible. An issue treatment is often using a high dose anti-inflammatory medication if you can safely take these, these are the things that I'd like to provide for my friends, and otherwise you can take some pain relief such as parasyte or you. When you go to see a doctor, they might prescribe other things, right? Yeah, so initially for the attack itself, your doctor may offer you one of a few different things. One medicine you might have heard about as culture scene, which is a special type of anti-inflammatory that can be very effective at treating gap. Often people describe their gap melting away when they start it. It does have some side effects, particularly when we talk about this diarrhea, and unfortunately, once it starts, the only way to stop it is to stop the medication. So, we do tell people to do, do stop it straight away if you get diarrhea. Alternatively, you might be offered a non-steroidal anti-inflammatory such as ibuprofen or the doctor may choose a prescription version that's suitable for you, and a last resort is actually prednisoline, so steroids, which again, are really effective, but it depends on your individual circumstances as to whether that would be chosen. In all three cases, particularly ibuprofen group and the steroids, you would be offered a tummy protector usually to help reduce the risk of tummy irritation, including ulcers that can fall by taking these medicines. We're going to put some links to the UK Cancer Society, which is a really good, very good website there. So, let's talk about foods that are high in those purines that we talked about. We need to avoid. So, awful liver, kidneys and heart, gain, so phesan, rabbit, venison, oily fish, anchovies, herring, macrol, sardines, trout, and other seafoods as well, unfortunately, including crab strips, meat and yeast extracts like marmite and bovral and commercial gravis, quite high in purines. There are also foods that are classes of moderate purine foods, and these are not to be avoided, but maybe to be eaten in moderation for good. So, meat in itself is beef, lamb, chicken and pork, poultry, chicken and duck, dried beans, peas, legumes, baked beans, kidney beans, soybeans, peas, etc. Mushrooms and microprotein, so that's the single cell protein meat alternatives. Some vegetables, asparagus, cauliflower, spinach, thick and tain, moderate levels of purines, and home grains, which is a brand, and home bread, also imported purines. Yeah. Yeah. And there's some other things that you should work on. Don't forget to just drink plenty of clear fluid, so really water is key, not only for preventing, we're helping to prevent gout, but actually we mentioned that kidney stones as well, there is that that imported link and hydration helps protect you from that. Yeah. And then losing weight is helpful as well, protects the joints, but also helps. And also learn how to treat an acute attack of yourself. Sometimes some people carry a pill in pocket just in case, coltoseen, simple anti-flammatory medications as we discussed. If your clinician agrees and you respond really to steroids, you may be now told some steroids and stand by to try and catch the gout flare as soon as that happens. So, something we called ice, sometimes it's using ice, it means cool, compression and elevation and resting, and let your GP know when you get to the episode. But there are other things you can do as well not let to help prevent gout or prevent further episodes again. Yeah, indeed. So you might have feel like you've exhausted all of the lifestyle changes and unfortunately you are still experiencing attacks, or maybe your GP has offered you serial tests of your uric acid levels and the levels are just not improving. Then we might start to look at other medicines and you might be offered a medicine called alapurinol. So this is our first line treatment. It's called a xanthine oxidase inhibitor. And what it does is it works to reduce the uric acid levels in your body. And by doing that, it will simply as a result of that reduce the frequency of the episodes, many people who even start on the first dose that often don't have an attack the years do they? It is important to know that if you're starting that you're usually recommended to take a low dose of one of the gout acute attack tablets every day for the first few perhaps days or weeks whilst you're starting alapurinol because there is a small risk that it can cause an attack whilst it's getting into the system. And if you're interested in numbers then you are trying to get your uric acid level ideally below 360 and actually they're pushing the level loads to 300 if we can. Actually we see lots of people who keep getting in pairs of gout, they may be not that they uric acid levels check for a while. I think they're on a fairly high dose of alapurinol, but when we check their levels are in the 400s and the 40s going to keep getting gout, maybe he's trying to drive that uric acid level down, that's the thing that we need to do is it and so those numbers are useful. Yes, absolutely. And finally it can be helpful to nudge your doctors to think about your other medications. So sometimes you're on other medicines, maybe you're on something for your blood pressure or your heart and ironically it's as a side effect pushing up your uric acid levels and it's just worth checking that you're not on anything that could be causing that because it could be a easy win to fix up. There are some things to be where we touched on these earlier but gout often has a few mimics. So osteoarthritis where and tear arthritis. Essentially arthritis if we think about it is an inflammation of the joints. From any reason. So osteoarthritis where and tear arthritis will cause similar symptoms to the inflammation that gout will cause. But there are other forms of an inflammatory arthritis which are likely but that leads us on safety netto because there are some things to look out for that could indicate the forms of arthritis that may be more dangerous. Indeed. Yes. So if you develop symptoms that are beyond what we said so if the redness is spreading from the affected joint or you've developed a fever that's really important to think about infection which is quite uncommon but really important not to miss. Yes. We also wanted to just highlight that dire rear side effect to call just seen in particular didn't we? And also if you are being prescribed anti-inflammatories or you're taking let's say you're buying ibuprofen over the counter then just need to think about your tummy lining so your stomach lining which could be at risk of irritation and ulcers and also your kidney health as well. So Jeff and he take her points from this podcast? Yeah. We were having a chat before we started recording and I think a lot of people still think of gout as a disease or condition of highly affluent people who have very luxurious diets. A lot of people come and say well I can't have gout. I don't drink any port. I don't eat stilton. Well actually that stereotype of the rich affluent person getting gout and nobody else would kind of applies to days that are long gone now where you have rich landowners, barons and all of the matter and then quite poor service and servants who work the land. And the people who were very poor and very little didn't get gout salt because their diets were so poor and it was the people who own the land who got rich and ate very fantastically well over so often and they wouldn't be gout. And if we look at today most of us probably listening to this are going to fall into that category and so I think it is more likely that gout is good to be associated with and what we're eating. Yes. Rather than the fact that we don't drink port or eat stilton. We're going to say it's we have to have quite a lot of people who are if diet compared to what people might do on the diet. Yeah. What about you? I probably want to reiterate the importance of managing an attack appropriately. A rheumatology specialist, a joint specialist in gout would say re-import to have the attacks controlled and have as a minimal number of those as you can. And also to think about the rest of your body so if you have an individual attack of gout don't forget it could be a sign of another problem underneath it might have be worth exploring. This has been an episode of Coffee Break. We hope you have enjoyed it and if you have then we hope you will join us again for another coffee break soon. Remember if you do want to get in touch with us or if you have any ideas or suggestions then please feel free to email us at the show at [email protected] You can listen to us and subscribe to the show on any of the podcast platforms and via your computer, smartphone and home smart devices. We have used a variety of resources for the information in the show to try and ensure that it is up to date and the most applicable. We have also put any important links we've discussed in the show notes. Coffee Break is a coffee break production and is created written and hosted by me, Dr Sam McGinley and me, Dr Jeff Han. The editor and producer is Dr Jeff Han. All the content we provide in the show is for general informational purposes only. The content does not constitute medical or healthcare advice. The content is valid in England at the time of recording. The content should not be relied upon as a substitute for professional medical or healthcare advice applicable to your specific circumstances. We advise that you always consult a qualified medical professional for any medical matters. [MUSIC]