Soru

A $58$-year-old man presents to the emergency department with a $12$-hour history of severe right knee pain and swelling. He reports the pain woke him up from sleep and is exacerbated by the weight of his bedsheets. His medical history is significant for HIV, hypertension, and chronic kidney disease stage 3a. His current medications include darunavir, cobicistat, emtricitabine, tenofovir alafenamide, lisinopril, and amlodipine. His viral load is undetectable, and his CD4 count is $620/\text{mm}^3$. Temperature is $37.6^\circ\text{C}$ ($99.7^\circ\text{F}$), blood pressure is $142/88\text{ mmHg}$, and pulse is $92/\text{min}$. Physical examination reveals a warm, erythematous, and exquisitely tender right knee with a noticeable effusion. Laboratory studies show a serum creatinine of $1.9\text{ mg/dL}$ (baseline $1.8\text{ mg/dL}$) and a serum uric acid level of $9.4\text{ mg/dL}$. Arthrocentesis yields cloudy yellow synovial fluid with a leukocyte count of $62,000/\text{mm}^3$ ($88\%$ neutrophils). Gram stain reveals no organisms. Polarized light microscopy of the fluid demonstrates needle-shaped, negatively birefringent crystals. Which of the following is the most appropriate initial pharmacologic intervention for this patient's acute joint condition?