Calcium pyrophosphate deposition disease (pseudogout) Quiz: Ace Your Exams

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A 68-year-old woman presents to the clinic with a 3-day history of severe right knee pain, swelling, and difficulty moving the affected joint. Past medical history is significant for type 2 diabetes mellitus and diabetic nephropathy. BMI is 33 kg/m2. Temperature is 36.8°C (98.2°F), heart rate is 78/min, blood pressure is 135/85 mm Hg, respiratory rate is 16/min, and oxygen saturation is 97% on room air. Physical examination reveals right knee warmth and swelling with tenderness to palpation and limited range of motion. Laboratory evaluation is significant for creatinine of 2.5 mg/dL and elevated ESR and CRP. X-ray of the right knee is significant for the presence of chondrocalcinosis. Synovial fluid analysis shows a white blood cell count of 10,000 microL and positively birefringent rhomboid-shaped crystals. Which of the following is the best next step in management?

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