Despite the high prevalence of disease, gout management is frequently poor, with low patient adherence to urate-lowering therapy and attainment of recommended serum urate targets. Recent research has explored the patient's experience of gout, providing new understanding of the impact of disease. Pain is central to the patient's experience of gout. Poorly controlled gout leads to limitation of activities, reduced participation, and poor health-related quality of life. Although effective gout management with urate-lowering therapy improves many patient-reported outcomes in clinical trials, major gaps exist in patient understanding of disease and adherence to long-term urate-lowering therapy. Furthermore, a large mismatch in the perceptions of gout and its therapy exists between patients and health care practitioners. These issues may contribute to progressive and poorly controlled disease despite the availability of effective treatment. These findings provide potential pathways to improved clinical care of patients with gout. Work is now required to identify the optimal models of care for patients with gout that can be tested in clinical trials using outcome measures of relevance to individuals with this disease.