Gout is a growing health problem, affecting approximately 7% of men and 3% of women over the age of 65 years. Although effective therapies for gout management exist, quality in gout care has been too frequently characterized as being "suboptimal." This review examines issues pertinent to quality of care in gouty arthritis with a focus on initial reports examining suboptimal care, subsequent efforts to develop quality of care indicators for gout management, more recently published evidence-based recommendations for gout diagnosis and treatment, and an ongoing international initiative to develop core outcome measures for acute and chronic gout. "If you can not measure it, you can not improve it" - Lord Kelvin.