Sign-Podagra (presence of tophi in the first metatarsophalangeal joint gives us that)
Provisional DDx- Tophaceous Gout.
To confirm-X-ray study and FNAC and study, Blood uric acid, WBC and DLC count-Also if to be extra extra quick- one can s

tart empirical treatment with Antibiotics like Vancomycin or gentamycin-
Treatment- Apart from empirical-NSAID's, Colchicine, sulfasalazine, methotrexate, penicillamine, etc.(immunosuppressants) and of course Allopurinol.