A 79-year-old woman with an estimated glomerular filtration rate near 25 mL/min/1.73 m² takes rivaroxaban for atrial fibrillation and presents with an acute, crystal-proven gout attack. A clinical photograph of her affected foot is shown below.
Which treatment is most appropriate?

Severe chronic kidney disease and anticoagulation make NSAIDs hazardous because of renal and bleeding risks. A short course of oral corticosteroid is an appropriate treatment for an uncomplicated acute gout flare when infection has been excluded.
