Gout is a common complex disorder resulting from variable interaction between genetic, constitutional, and environmental factors. Heritability of gout is around 60%, and individual dietary factors account for < 1% of serum urate (SU) variance compared with 24% from the genetic variations currently identified. The most common presentation is a gout flare, characterised by acute onset of one or occasionally more hot, red, swollen joints which are extremely painful. Treat-to-target urate-lowering therapy aims to reduce and maintain urate levels in peripheral joint tissues well below saturation (SU < 360 µmol/L). This prevents further crystal formation and gradually dissolves away existing crystals, after which no further flares occur, and further risk of crystal-induced joint damage is removed.