Gouty arthritis is the most common inflammatory arthritis in the world. The main feature of the disease is the deposition of monosodium urate crystals, which are the key driver of acute inflammation. The prevalence and incidence of gouty arthritis are increasing in many developed countries worldwide, but despite a good understanding of the pathophysiology of the disease and available therapies, the burden of gouty arthritis still remains high, and treatment is still suboptimal. The mainstay of treatment for gouty arthritis is urate reduction using ULT, which includes xanthine oxidase inhibitors, uricosurics, and recombinant porcine-like uricase. Treatment of gout attacks is carried out in the first line with non-steroidal anti-inflammatory drugs, colchicine or glucocorticoids, and in the second line of therapy with IL-1 inhibitors. Innovations in the treatment of gout include new therapies that modulate inflammatory pathways, such as Dapansutril, which inhibits NLRP3, and beta-carotene, which reduces inflammation induced by MSU crystals. Gut microbiota also plays an important role, so dietary interventions and faecal microbiota transplantation are being investigated as new therapeutic strategies. The treat-to-target (T2T) approach is a recently established approach to improve the management of gout, aiming to achieve a target serum urate level below 6 mg/dL. All these innovations represent progress in the treatment of gouty arthritis.