Crystal-associated arthritis includes gout, calcium pyrophosphate deposition (CPPD) disease, and the basic calcium phosphate (BCP)-related syndromes. In this article, the authors discuss the use of drug combinations and steroids for refractory gout patients and recommend management strategies for gout in the organ transplant recipient. Difficult cases of CPPD disease can be treated with colchicine and intra-articular steroids. The BCP-associated syndromes are best managed with NSAIDs and intraarticular measures. Experimental therapies for all forms of crystal-related arthritis are also discussed.