Rheumatology and Musculoskeletalmiddle twist
A 61-year-old man presents with 24 hours of severe pain, redness and swelling of his right first metatarsophalangeal joint, left ankle and right knee. He has had two previous single-joint attacks treated with indomethacin. He has chronic kidney disease with an estimated glomerular filtration rate of 24 mL/min/1.73 m², type 2 diabetes and ischaemic heart disease, and four days ago he was started on clarithromycin by another doctor for a chest infection. Aspiration of the knee shows needle-shaped negatively birefringent crystals and no organisms.
Which one of the following is the most appropriate treatment for this attack?