Background: Few diseases that confront the 21st century clinician have documented history which dates back to early human era.

Methods: We reviewed how the understanding of the aetiogenesis, symptomatology, diagnosis and treatment of gout including myths have evolved and discussed the implications thereof.

Results: Gout has been recognized as a clinical entity before 2000BC with Hippocrates describing the five aphorism of gout. Between the 1st and the 6th century AD, the role of genetics and the association of gout with an indulgent lifestyle and tophi were described. Hemodactyl (a source of colchicines) was also first identified during this period. “Gout” was coined from the Latin word “Gutta” in the 13th century and the microscopy of uric acid crystals and gout symptomatology were the focus of investigations between the 17th and 18th centuries. Several drug treatments were developed between the 19th and 20th centuries including salicylates, probenecid and allopurinol. Gout as a risk factor for metabolic syndrome, NIDDM and cardiovascular disease is a challenge for the 20th century and the future.

Conclusion: The understanding of gout has evolved with human development but the challenges for the future will include how to deal with the associated cardiovascular co-morbidities.