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17052 Medicine

A 40-year-old obese man presents with intense pain in his left first metatarsophalangeal (MTP) joint for the past few hours. He has no history of trauma, fever, chills, and no previous similar episode. He has no history of renal disease or diabetes though he has been told he is “prediabetic.” He does not recall any recent skin infections and no family members have had any reported staphylococcal infection. On examination he has a swollen, red, warm, tender first MTP joint on the left. Uric acid level is 9 mg/dL; serum creatinine is normal. What is the best treatment approach for this patient?

AStart allopurinol immediately and titrate for a uric acid level below 6. Add colchicine if this is not effective within the first 24 hours.
BBegin prednisone until symptoms subside.
CBegin indomethacin. As the patient improves, reduce the dose to minimize gastrointestinal side effects.
DPrescribe a narcotic until pain is under control.
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