Soru

A 71-year-old man presents to the primary care clinic reporting intense pain and swelling in his right big toe that began abruptly overnight. He states the pain is so severe that he cannot bear weight on his foot or tolerate the touch of a bedsheet. His medical history is significant for ischemic cardiomyopathy with a left ventricular ejection fraction of $30\%$, stage 4 chronic kidney disease with a baseline estimated glomerular filtration rate of $24 \text{ mL/min/1.73 m}^2$, and a hospitalized episode of bleeding peptic ulcer disease three years ago. His current daily medications include carvedilol, sacubitril-valsartan, and low-dose aspirin. Vital signs are temperature $37.2^\circ\text{C}$ ($99.0^\circ\text{F}$), blood pressure $118/76\text{ mmHg}$, and heart rate $78\text{/min}$. Physical examination reveals a markedly erythematous, warm, swollen, and exquisitely tender first metatarsophalangeal joint on the right foot. The remainder of the joint examination is unremarkable. Which of the following is the most appropriate initial pharmacologic intervention for this patient's acute joint pain?