There are actually in Spain three approved urate lowering therapies. All of them, alopurinol, febuxostat and benzbromarone have an efficacy off about 90 % . Some audits and surveys demonstrate that patients with gout, in general, are poorly treated and that the objective of maintaining the serum uric acid below 6 mg/dl is not achieved. In this paper we discuss the various pharmacological and nonpharmacological urate lowering therapies, we try to understand why the effectiveness of this therapies is so low and explain some interventions that has been published to improve it.