Monosodium urate (MSU) crystals are among the most potent pro-inflammatory stimuli and an innate immune inflammatory response to the crystal surface is intimately involved in the pathology of gouty arthritis. The responses of human neutrophils to MSU crystals represent an integral part of this innate response and a key component of the acute inflammatory response associated with gout. A significant, though incomplete, body of information concerning the implication of human neutrophils in MSU crystal-induced inflammation and the signal transduction pathways activated in response to these agonists in neutrophils has accumulated over the last few years. This review focuses on the current state of knowledge concerning the activation of human neutrophils by MSU crystals specifically in the context of acute gout, as recent data begin to draw a comprehensive picture of the events leading to the often excessive functional responses of neutrophils to these particulate agonists. A non-exhaustive list of the most important questions that remain to be assessed to further describe the physio-pathological mechanisms of gouty arthritis is presented here.