Mr V.S., aged 76, is in your clinic complaining of 2 days of a red, swollen, and very painful right wrist and third proximal interphalangeal joint. He denies any trauma and states that this is similar to previous gout attacks. He was diagnosed with gouty arthritis about 10 years ago and has not had an attack for 3 years. He went to a medical clinic yesterday and was prescribed colchicine, 0.6 mg 3 times daily. Today he has severe nausea, mild diarrhea, and his hand does not feel much better. Examination confirms severe acute inflammatory arthritis.
Mr V.S. has long-standing hypertension, chronic atrial fibrillation, chronic kidney disease (estimated glomerular filtration rate of 35 mL/min), and obesity (body mass index of 32 kg/m2). Current medications include amlodipine 10 mg daily, perindopril 4 mg daily, hydrochlorothiazide 25 mg daily (dose increased from 12.5 mg daily about 6 months ago), metoprolol 25 mg twice daily, and warfarin 5 mg daily. He is an ex-smoker and abstains from alcohol. What are your therapeutic options for this acute episode of gouty arthritis?