Gout Quiz: Ace Your Exams

A 58-year-old man presents to the primary care clinic due to severe pain, swelling, and redness in his right big toe. He reports that the pain started abruptly in the middle of the night, waking him from sleep. His past medical history is significant for hypertension for which he takes hydrochlorothiazide. He reports a 20-pack-year smoking history, alcohol consumption of a few beers occasionally on weekends, and a diet rich in carbohydrates. Family history is significant for rheumatoid arthritis in his mother. He denies recent trauma to the foot or history of joint disease. Temperature is 37.1°C (98.9°F), blood pressure is 145/84 mmHg, pulse is 96/min, respiratory rate is 22/min, and oxygen saturation is 98% on room air. The patient appears to be in pain. Physical examination is significant for tenderness, swelling, and erythema of the metatarsophalangeal joint of the right big toe. There is limitation to both passive and active range of motion. Which of the following factors in this patient's history likely increased his risk of developing this condition?