Gout flares are usually self-limiting inflammatory reactions that exhibit disappearance of redness, swelling and severe pain in the joints within 7–10 days, and may be associated with rapid induction of anti-inflammatory factors like Transforming growth factor beta 1 (TGFβ1), interleukin (IL)-10 and soluble tumour necrosis factor (TNF) receptors as well as intracellular cytokine negative regulators like cytokine inducible SH2-containing protein and regulatory immune cells.1 Nevertheless, the prevalence and incidence of refractory and chronic gout have continued to increase. The gene discussed is CISH; the disease is gout.