Soru

A 65-year-old man is evaluated in the clinic for the abrupt onset of intense pain, redness, and swelling in his left great toe. The symptoms awoke him from sleep last night, and the pain is exacerbated by the slightest touch, including the weight of a bedsheet. His medical history includes ischemic cardiomyopathy with a left ventricular ejection fraction of $25\%$, type 2 diabetes mellitus, and stage 4 chronic kidney disease. Current daily medications are carvedilol, sacubitril-valsartan, empagliflozin, and low-dose aspirin. Vital signs include a temperature of $37.1^\circ\text{C}$ ($98.8^\circ\text{F}$), blood pressure of $112/68 \text{ mm Hg}$, and pulse of $72 \text{ /min}$. On physical examination, the left first metatarsophalangeal joint is erythematous, swollen, and exquisitely tender. Laboratory analysis reveals a serum creatinine of $2.6 \text{ mg/dL}$ (estimated glomerular filtration rate of $22 \text{ mL/min/1.73 m}^2$) and a serum uric acid level of $9.2 \text{ mg/dL}$. Synovial fluid analysis from the affected joint demonstrates a leukocyte count of $25,000 \text{ /mm}^3$ with $90\%$ neutrophils and the presence of needle-shaped, negatively birefringent crystals. Which of the following is the most appropriate initial pharmacologic intervention for this patient?