<prompt> Please answer with one of the option in the bracket. Write reasoning in between . Write answer in between .Q:A 55-year-old man presents after an episode of severe left ankle pain. The pain has resolved, but he decided to come in for evaluation as he has had pain like this before. He says he has experienced similar episodes of intense pain in the same ankle and his left knee in the past, which he associates with eating copious amounts of fatty food during parties. On one occasion the pain was so excruciating, he went to the emergency room, where an arthrocentesis was performed, revealing needle-shaped negatively birefringent crystals and a high neutrophil count in the synovial fluid. His past medical history is relevant for essential hypertension which is managed with hydrochlorothiazide 20 mgday. His vital signs are stable, and his body temperature is 36.5C 97.7F. Physical examination shows a minimally tender left ankle with full range of motion. Which of the following is the most appropriate long-term treatment in this patient? ? A: Colchicine, B: Nonsteroidal antiinflammatory drugs NSAIDs, C: Uricosuric drug, D: Intra-articular steroid injection, E: Xanthine oxidase inhibitor,  <response>: This is a clinical vignette describing a 55-year-old man with recurrent episodes of severe ankle and knee pain triggered by eating fatty foods. He has a history of similar episodes in the past that required arthrocentesis, which revealed negatively birefringent crystals and neutrophilia suggestive of gout. He also has a history of hypertension managed with a thiazide diuretic. The question asks about the most appropriate long-term treatment for this patient.Based on the clinical history and arthrocentesis findings, this patient most likely has gout caused by hyperuricemia. The thiazide diuretic he takes for hypertension can contribute to hyperuricemia. The goal of long-term therapy is to reduce serum uric acid levels to prevent further gout attacks. Colchicine treats acute gout flares but does not lower uric acid. NSAIDs treat pain but do not affect uric acid levels. Steroid injections can help acute attacks but do not prevent recurrences. A xanthine oxidase inhibitor like allopurinol or febuxostat blocks uric acid production and is the most appropriate long-term therapy.E: Xanthine oxidase inhibitor 