A 56-year-old man comes to the physician because of a 1-day history of sudden severe pain in his right great toe. He has never had such symptoms before. Four months ago, He has a history of nephrolithiasis and hypertension treated with hydrochlorothiazide. Examination shows erythema, swelling, warmth, and tenderness of the right metatarsophalangeal joint; range of movement is limited by pain. His serum uric acid is 12 mg/dL. Arthrocentesis yields cloudy fluid with a leukocyte count of 18,500/mm3 (80% segmented neutrophils). Polarized light microscopy of the synovial fluid is shown. Which of the following is the best initial treatment for this patient?

Question

Quizplus · Accepted Answer

Eductional Objective: Nonsteroidal anti-inflammatory drugs are the first-line treatment for acute gouty arthritis.  They inhibit cyclooxygenase and therefore decrease prostaglandin synthesis and exert a broad anti-inflammatory effect that includes inhibition of neutrophils.

A 56-Year-Old Man Comes to the Physician Because of a 1-Day