The presence of metabolic syndrome (MS) is characteristic for many patients with gout. MS is closely associated with a generalized disorder called insulin resistance (IR) or impaired tissue responsiveness to the normal action in insulin. MS and IR define cardiovascular disease risks and are the main factors leading to severe disease associated with chronic arthritis and struck joints in gout patients. Given serious complications associated with MS, this frequent comorbidity should be recognized and be taken into account in the long-term treatment and overall health of individuals with gout. The review is devoted to studying MS and IR in gout patients.