Acute Gout in Chronic Kidney Disease: Choosing a Safe Anti-Inflammatory

Patient B-217 is a 68-year-old man with chronic kidney disease stage 3b, hypertension, and type 2 diabetes mellitus. He weighs 82 kg. He presents with a 12-hour history of severe pain, swelling, and redness of the right great toe. He had two similar episodes in the past year, which resolved without treatment. On examination, the right first metatarsophalangeal joint is warm, swollen, and exquisitely tender. The overlying skin is shiny and red. His temperature is 37.3°C. He has no drug allergies. His current medications are lisinopril 10 mg once daily, metformin 500 mg twice daily, and amlodipine 5 mg once daily. He takes no other regular medicines or herbal remedies. He is a non-smoker and drinks four units of alcohol per week. Recent investigations show serum creatinine 1.8 mg/dL (eGFR 38 mL/min/1.73 m²), serum uric acid 8.9 mg/dL, white cell count 11.2 × 10⁹/L and C-reactive protein 39 mg/L. Other blood tests, including liver function tests, are within normal limits. Please prescribe an appropriate anti-inflammatory treatment for this acute attack of gout.