Although high prevalence of gout in Māori and Pacific people is well-documented, the experience of disease in these groups has not been explored in detail. The aim of this analysis was to describe the experience and impact of gout in Māori and Pacific people. Patients with gout for <10 years were recruited from primary and secondary care settings into a prospective observational study (n = 291; 37 Māori, 35 Pacific, and 219 not Māori or Pacific). Participants attended a baseline study visit which included a comprehensive clinical assessment. Serum urate, flare frequency and activity limitation were recorded at baseline and after 1 year. Māori and Pacific participants had earlier age of onset (by 9 years), higher flare frequency and more features of joint inflammation. Serum urate concentrations were higher in the Māori and Pacific patients at baseline, despite greater use of allopurinol. Māori and Pacific patients reported greater pain and activity limitation and lower health-related quality of life. The cost of gout treatment was more than three times higher in the Māori and Pacific patients. After 1 year, the higher flare frequency and activity limitation persisted in the Māori and Pacific patients. Māori and Pacific people with gout experience early onset, severe disease with frequent flares and poorly controlled hyperuricaemia. Māori and Pacific ethnicity should be recognised as a prognostic factor for more severe outcomes in this disease, and intensive efforts should be made to work with these patients to control serum urate and prevent flares.