question: Q:A 52-year-old woman comes to the physician because of a 3-week history of pain in her right knee. The pain is worse at the end of the day and when she walks. She says that it has become difficult for her to walk up the flight of stairs to reach her apartment. She has hypertension and psoriasis. Her sister has rheumatoid arthritis. She drinks 2–3 beers daily. Current medications include hydrochlorothiazide, topical betamethasone, and a multivitamin. She is 160 cm (5 ft 3 in) tall and weighs 92 kg (202 lb); BMI is 36 kg/m2. She appears anxious. Her temperature is 37°C (98.6°F), pulse is 87/min, and blood pressure is 135/83 mm Hg. Cardiopulmonary examinations shows no abnormalities. There are several scaly plaques over the patient's upper and lower extremities. The right knee is not tender nor erythematous; range of motion is limited. Crepitus is heard on flexion and extension of the knee. Her hemoglobin concentration is 12.6 g/dL, leukocyte count is 9,000/mm3, and erythrocyte sedimentation rate is 16 mm/h. An x-ray of the right knee is shown. Which of the following is the most appropriate next step in the management of this patient?? 
  {'A': 'Intraarticular glucocorticoid injections', 'B': 'Weight loss program', 'C': 'Total joint replacement', 'D': 'Methotrexate therapy', 'E': 'Colchicine therapy'},