The treatment of an acute flare of gout consists of non-steroidal anti-inflammatory drugs like ibuprofen, steroids, and colchicine. Colchicine interacts with multiple pro- and anti-inflammatory pathways activated by monosodium urate crystals. It prevents microtubule assembly, disrupts inflammasome activation, microtubule-based cell chemotaxis, generation of leukotrienes and cytokines, as well as phagocytosis. Suppression of many of these cellular processes also benefits other comorbid conditions associated with gout, such as osteoarthritis and cardiovascular disease. Prevention of future flares requires dietary and lifestyle changes, including losing weight, limiting intake of alcohol and red meats, and changing or stopping diuretics (thiazide or loop). The image shows gouty tophi eroding sesamoid bone of foot. Image courtesy of: Ed Uthman, Houston, TX.