Joint Pain in a Young College Athlete

Pertinent Physical Examination Findings E.Z.'s vital signs are as follows: weight of 361 lb, body mass index of 40.24, temperature of 98.7°F, heart rate of 64 beats/min, blood pressure of 136/86 mm Hg, and respiration rate of 16 breaths/min. Head: normal cephalic head without trauma Eyes: pupils are equal, round, reactive to light and accommodation, and the conjunctiva and sclera are clear without nystagmus Ears: tympanic membrane is intact and a pearly color Nose: no redness, septum deviation, or drainage Mouth: teeth are clean and in alignment, there is no decay, the tongue is pink and moist, there are no ulcers Neck: large and no masses, thyromegaly, or abnormal cervical nodes are present Lungs: clear to auscultation Heart: regular rhythm and rate and no murmurs or gallops Abdomen: soft, bowel sounds present in all 4 quadrants, nontender to palpation, and no masses or organomegaly Joints: full range of motion, no edema, no redness, nontender on palpation, pulses intact, and brisk cap refill E.Z. has normal hair growth on his legs and normal toenail growth with no discoloration or nail bed changes. Obesity: dietary factors Serum urate-elevating medications Excessive alcohol intake History of urolithiasis Metabolic syndrome Coronary artery disease Hypertension Chronic kidney disease Hyperlipidemia Lead poisoning Table 1 Comorbidity Checklist for Gout2 Avoid Limit Encourage High purine-sweet bread, liver, and kidney meats Serving sizes of beef, lamb, pork, and seafood with high-purine content (eg, shellfish and sardines) Low-fat or nonfat dairy products High-fructose corn syrup: sodas, beverages, and foods Servings of naturally sweet fruit juices, table sugar, sweetened beverages, desserts, and table salts including sauces and gravies Vegetables Alcohol overuse: more than 2 servings for males, more than 1 serving for females Alcohol, particularly beer, wine, and spirits