Gout is a metabolic disorder resulting from the accumulation of sodium urate in the body due to reduced renal clearance or (less frequently) increased production of uric acid or excessive purine intake. Allopurinol, colchicine, and uricosuric drugs are routinely used to treat gout, but they are not always effective and/or well tolerated. Increasing incidence of gout in elderly patients with significant comorbidities makes the treatment even more challenging. Febuxostat, a new strong inhibitor of xanthine oxidase, is more effective than allopurinol in reducing serum urate level and is recommended for use in patients with kidney failure and those with the highest serum urate levels and tophaceous gout. Pegloticase, pegylated mammalian uricase transforming uric acid into allantoin, has proven effective in refractory gout, but high treatment costs, immunogenicity, as well as common adverse drug reactions remain a concern. Interleukin 1 (IL-1) antagonists show efficacy in treating acute gout flares.