Tophi may also form inside bone near the joints, in the kidneys, and in other organs and tissues, causing permanent damage. Advances in treatment, fortunately, have made this kind of chronic gout extremely rare. As with most illnesses, effective treatment of gout depends on a correct diagnosis. Gout can be unequivocally diagnosed by telltale uric acid crystals in joint fluid. If this picture adds up to a strong suspicion of gout, treatment can be started with the immediate goal of arresting the acute attack.
Acute gout is treated with drugs that block the inflammatory reaction.
One of the oldest agents known to be effective against acute gout is colchicine, which comes from a common European plant, the autumn crocus, and is marketed in this country primarily as a generic drug. An English clergyman, Sidney Smith, said a century and a half ago that he had only to go into his garden and hold out his gouty toe to the plant to obtain a prompt cure. This may have been an exaggeration, but a rapid response to colchicine suggests that the patient does indeed have gout. Steroids may be taken by mouth or by injection into the bloodstream or muscle. Drug treatment usually relieves the symptoms of acute gout within 48 hours.