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  • Review Article
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Hyperuricaemia and gout in the Pacific

Nature Reviews Rheumatology volume 21, pages 197–210 (2025)Cite this article

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Abstract

Gout is the most common form of inflammatory arthritis in adults worldwide. There has been a steady increase in prevalence, which varies across different geographic areas and is high in the Indigenous (First Nations) peoples of the Pacific region. Palaeo-archaeological studies demonstrate that gout was present in the Pacific region prior to European colonization, which is suggestive of genetic predisposition. Genetic risk factors, including population-specific genetic variants and genetic variants shared across populations, particularly those influencing urate transporters, have been identified in Indigenous peoples of the Pacific that partly explain the earlier age of onset of gout. Indigenous peoples of the Pacific experience severe gout, with frequent flares, high hospitalization rates and tophaceous gout, all aggravated by socio-cultural factors. Despite a specific need for effective gout management, Indigenous peoples of the Pacific are under-represented in gout research and inequities in care continue. Indigenous peoples-led, holistic gout management programmes are systematically and urgently required in this region, where gout is a major public health issue. Importantly, a foundation of cultural safety is necessary to underpin such programmes.

Key points

  • Indigenous peoples of the Pacific, particularly those of Polynesian descent, have a high prevalence of hyperuricaemia and gout.

  • The genetic basis of gout in Indigenous peoples of the Pacific is a composite of risk alleles shared between populations and population-specific risk alleles.

  • Gout in Indigenous peoples of the Pacific is severe, associated with family history and is experienced at a relatively young age.

  • Cardiometabolic and renal comorbidities are common in people with gout throughout the Pacific region, and their management and prevention are also required.

  • Health inequities continue to affect gout care for Indigenous peoples of the Pacific region.

  • Territorial, holistic health programmes are systematically and urgently required in this region, particularly to improve access to urate-lowering therapy.

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Fig. 1: Map of the Pacific region with the known national prevalences of hyperuricaemia and gout.

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Authors and Affiliations

  1. Department of Rheumatology, CHU Rouen, Rouen, France

    Baptiste Gérard

  2. Department of Physiology, University of Otago, Dunedin, Aotearoa New Zealand

    Megan Leask

  3. Department of Microbiology and Immunology, University of Otago, Dunedin, Aotearoa New Zealand

    Tony R. Merriman

  4. Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, AL, USA

    Tony R. Merriman

  5. Department of Rheumatology, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France

    Thomas Bardin

  6. Department of Internal Medicine, French Polynesia Hospital Centre, Papeete, Tahiti, French Polynesia

    Erwan Oehler

  7. Te Whareora o Tikipunga, Northland Clinical Site, University of Auckland, Whangarei, Aotearoa New Zealand

    Aniva Lawrence

  8. Oceania University of Medicine, Apia, Samoa

    Satupaitea Viali

  9. Pacific Health Section, University of Auckland, Auckland, Aotearoa New Zealand

    Samuela ‘Ofanoa

  10. Department of General Practice and Primary Health Care, University of Auckland, Auckland, Aotearoa New Zealand

    Leanne Te Karu

  11. Department of Medicine, University of Otago, Christchurch, Christchurch, Aotearoa New Zealand

    Lisa K. Stamp

  12. Department of Medicine, University of Auckland, Auckland, Aotearoa New Zealand

    Nicola Dalbeth

  13. Department of Rheumatology, Saint Philibert Hospital, Lille Catholic University, Lille, France

    Tristan Pascart

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  1. Baptiste Gérard
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The authors contributed equally to all aspects of the article.

Corresponding author

Correspondence to Tristan Pascart.

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Competing interests

N.D. has received consulting fees, speaker fees or grants from Aristea, Arthrosi, AstraZeneca, Avalo, Biomarin, Dexcel Pharma, Hikma, Horizon, JPI, JW Pharmaceutical Corporation, LG Chem, Novartis, PK Med, Protalix, PTC Therapeutics, Selecta, Shanton Pharma, Sobi and Unlocked Labs. T.R.M. has received research funding and consulting fees from Variant Bio. L.K.S. has received research funding from the New Zealand Health Research Council and consulting fees from Pharmac outside the submitted work. T.P. has received research funding from Variant Bio and honorary and consulting fees from Horizon Pharmaceuticals and Novartis, unrelated to this work. B.G., M.L., T.B., L.T.K., S.O., S.V., A.L. and E.O. declare no competing interests.

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Gérard, B., Leask, M., Merriman, T.R. et al. Hyperuricaemia and gout in the Pacific. Nat Rev Rheumatol 21, 197–210 (2025). https://doi.org/10.1038/s41584-025-01228-7

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