An elderly man with painful swelling of the big toe and a history of alcohol use drinks homemade distilled liquor. Which factor is most likely contributing to his gout risk?

• A. High-purine diet
• B. Thiazide diuretics
• C. Drinking homemade distilled liquor
• D. Obesity

Answer: (C)

Alcohol intake can trigger gout by two main means: it raises uric acid production and hampers its excretion. When ethanol is metabolized, lactate builds up and competes with uric acid for elimination by the kidneys, so uric acid stays higher in the blood. Ethanol also promotes turnover of purines, adding to uric acid production. Distilled spirits deliver ethanol rapidly and are classically linked to gout flares, especially when consumed as homemade liquor that may be consumed in large amounts or without moderation, often with dehydration—another factor that favors crystal formation in joints. Given his history of alcohol use, this factor best explains his gout risk. The other factors can contribute to gout in general, but without specific evidence of high-purine dieting, diuretic use, or obesity in this patient, the liquor consumption is the most likely driver.