1. What is your age range? 18-25 26-35 36-50 51-65 66-80 81+

2. GenderMaleFemale

3. Do you have a family history of gout?YesNo

4. How often do you eat purine-rich foods (for example liver, kidney, anchovies, sardines, beef, pork, lamb, etc)? Never A few times per year Once per month 1+ time per week

5. When drinking alcohol, how much do you consume in one sitting? I don't drink alcohol 2 drinks 4-5 drinks 6+ drinks

6. Do you have permanent damage to any of your joints?YesNo

7. Have you had a serious illness or infection in the last week?YesNo

8. How often do you feel stressed? A few times per year Once per month Once per week Every day

9. Have you been on a crash diet recently that caused you to suddenly lose weight?YesNo

10. Have you had surgery in the last month?YesNo

11. Are you currently taking any of the following medicines?

a. Cyclosporine (for patients who have had organ transplants) YesNo

b. Antibiotics such as clarithromycin, telithromycin, or erythromycin YesNo

c. HIV protease inhibitors, such as atazanavir, indinavir, nelfinavir, ritonavir, saquinavir, amprenavir, or fosamprenavir YesNo

d. Antifungals such as itraconazole, ketoconazole, or fluconazole YesNo

e. Water pills such as diltiazem, verapamil (for patients with high blood pressure) YesNo

f. Ranolazine (anti-angina medicine) YesNo

g. Nefazodone (for patients with depression) YesNo

h. Aprepitant (for nausea and vomiting) YesNo

i. Low-dose aspirin YesNo

j. Levodopa (for patients with Parkinson’s disease) YesNo