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?
Keep going — a set of ten like this one, one at a time.
Practise moreMore from Rheumatology and Musculoskeletal
See allA 19-year-old man had a closed mid-shaft tibial fracture reduced and placed in a below-knee cast eight hours ago after a football tackle. He now has severe pain…
Pre-internship · middle twist
A 24-year-old man fell onto his outstretched right hand playing football two days ago. He has pain at the base of the thumb that is worse gripping. On examinati…
Clinical rotations · common
A 72-year-old woman presents with three weeks of a new, persistent right-sided headache. Brushing her hair on that side has become painful, and her jaw begins t…
Pre-internship · middle twist
A 16-year-old female long-distance runner develops gradually worsening right groin pain over six weeks. She has recently increased her training volume and repor…
Clinical rotations · middle twist
A 68-year-old man presents with a 24-hour history of a painful, swollen right knee and is now unable to bear weight. He takes hydrochlorothiazide for hypertensi…
Clinical rotations · common