The treatment objectives in gout are to promptly terminate the acute flares and to prevent the long-term complications via chronic pharmacotherapy, usually with urate-lowering drugs, combined with diet and lifestyle changes. Published data indicate that adherence with pharmacotherapy is particularly poor in gout patients. In studies of pharmacy dispensing of gout medications, the percentage of patients with good adherence, defined as purchasing at least 80% of the prescribed amount of medication, ranged from 18 to 44%. In a comparative study showing a 36.8% adherence rate among gout patients, patients with hypertension or type 2 diabetes had considerably higher rates, of 72.3 and 65.4%, respectively. In addition, data are lacking on adherence to recommended dietary and lifestyle changes, whose importance has been emphasized in recent years. Poor adherence has well-documented adverse consequences on the treatment success rate and on disease progression. These data identify treatment adherence in gout as a key target of patient education.