Hyperuricaemia and gout in the Pacific

Area of Science:

• Rheumatology
• Genetics
• Public Health

Background:

• Gout is the most common inflammatory arthritis globally, with increasing prevalence.
• Indigenous peoples of the Pacific exhibit a high prevalence and severity of gout, including early onset and tophaceous disease.
• Palaeo-archaeological evidence suggests a long-standing presence of gout in the Pacific, indicating potential genetic predisposition.

Purpose of the Study:

• To explore the genetic factors contributing to gout in Indigenous peoples of the Pacific.
• To highlight the severe clinical manifestations and socio-cultural factors exacerbating gout in this population.
• To emphasize the urgent need for culturally safe, Indigenous-led gout management programs.

Main Methods:

• Review of palaeo-archaeological studies on gout in the Pacific.
• Identification of genetic risk factors, including population-specific variants affecting urate transporters.
• Analysis of clinical presentation, hospitalization rates, and socio-cultural impacts on gout severity.

Main Results:

• Genetic risk factors, including shared and population-specific variants influencing urate transporters, contribute to gout's early onset in Indigenous Pacific peoples.
• This population experiences severe gout with frequent flares, high hospitalization rates, and tophaceous disease.
• Socio-cultural factors significantly aggravate gout severity.

Conclusions:

• Genetic predisposition plays a role in the high burden of gout among Indigenous peoples of the Pacific.
• Significant inequities in gout research and care persist for this population.
• Holistic, culturally safe, and Indigenous-led gout management programs are critically required to address this major public health issue.