Dr Ray O’Connor takes a look at recent clinical papers on gout, and how lifestyle and dietary factors play crucial roles in its management
Gout has historically been known as the “disease of kings” or “king of diseases” because of its acknowledged presence throughout history. It was first reported by Hippocrates in ancient Greece. It is a common and debilitating form of inflammatory arthritis caused by the deposition of monosodium urate (MSU) crystals in the joints.
Recurrent flares are described as recurrent attacks of acute inflammatory arthritis. It is characterized by the involvement of the first big toe and the large distal joints of the lower extremities. These flares indicate chronic gout or poor adherence to gout management.
Unfortunately, recurrent flares are believed to be among the most excruciating episodes experienced by individuals. Due to its severe symptoms and related joint swelling, gout significantly affects quality of life.
Dr Ray O’Connor
Although pharmacological treatments are effective, lifestyle and dietary factors play crucial roles in managing gout and its flares. The aim of this systematic review1 was to assess the effect of lifestyle factors, physical activity, and dietary patterns on serum uric acid levels and gout activity.
A search of PubMed, BMJ journals, and Google Scholar identified eight studies, involving 47,879 participants (predominantly males [78.5–95.3 per cent], aged 55–66 years).
Eligible studies focused on adults with gout and examined the lifestyle or dietary factors affecting uric acid levels or gout activity. The review followed a pre-specified protocol. To optimize the quality, the bias risk was assessed. The findings suggest that consuming polyunsaturated fatty acid-rich fish, regular physical activity, and increased vegetable intake may reduce gout flares.
Conversely, high purine intake (especially animal sources), excessive alcohol consumption, and obesity are risk factors for gout exacerbation.
Some studies have reported reduced serum uric acid levels with dietary changes, whereas others have found no significant effect. The authors’ conclusion was that their findings emphasize the importance of dietary and lifestyle factors in managing serum uric acid levels and reducing the risk of gout flares. They recommend that further research is required to establish clinical recommendations to improve patient outcomes.
While consumption of alcohol is associated with gout flare ups, what about other beverages?
This meta-analysis2 aimed to investigate the association between sugar-sweetened beverages (SSBs), fructose, and the risk of gout and hyperuricemia. Following PRISMA guidelines, the authors systematically searched PubMed, EMBASE, and Cochrane Library for observational studies from inception to March 2025. Adjusted odds ratios (ORs) with 95 per cent confidence intervals (CIs) were pooled. Subgroup analyses explored sex. Heterogeneity (I2) and publication bias were assessed. A total of 22 studies (235,790 participants) were included.
SSB intake significantly increased the risk of hyperuricemia (OR = 1.33) and gout (OR = 1.21). Fruit juice (FJ) showed a modest association with hyperuricemia (OR = 1.15) and an increased risk of gout (OR = 1.28). Fructose consumption was strongly associated with increased gout risk (OR = 1.66), but its relationship with hyperuricemia was inconsistent (OR = 1.12). Diet soft drinks showed a modest association with gout (OR = 1.14). The authors’ conclusion was that SSB consumption is associated with increased risks of hyperuricemia and gout.
A treat-to-target approach is recommended for gout management, which involves titrating urate-lowering therapy to reach a serum urate target of less than 0·36 mmol/L, but evidence from pragmatic, head-to-head trials comparing a treat-to-target strategy with a symptom-driven approach is scarce.
The aim of this study3 was to compare these two approaches in patients with gout. The study design was a multicentre, open-label, pragmatic, randomised controlled trial at eight secondary care rheumatology centres in the Netherlands.
Participants aged 18 years or older with gout and hyperuricaemia (typically defined as a serum urate concentration of >0·36 mmol/L), and not currently using urate-lowering therapy were randomly assigned (1:1) using a computer-generated allocation sequence to receive either a treat-to-target strategy to reach a target serum urate concentration of less than 0·36 mmol/L with structured serum urate-guided titration of oral urate-lowering therapy (including first-line allopurinol and second-line oral febuxostat or oral benzbromarone) or symptom-driven management, in which the physicians and patients decided whether to initiate urate-lowering therapy based on symptoms, and the type and dose were determined at the physician’s discretion without a specific serum urate target.
Because of the pragmatic design, participants and investigators were not masked to treatment allocation. The primary outcome was remission during months 18–24 of follow-up, defined as absence of gout flares during months 18–24, no subcutaneous tophi at month 24, a patient-reported pain score of less than two, and a patient global assessment of disease activity score of more than eight.
Analyses were done according to the intention-to-treat principle using multiple imputation for missing data, and all randomly assigned participants were included in the primary efficacy and safety analyses.
Between March 4, 2021, and Nov 4, 2022, 308 participants were randomly assigned, of whom 268 (87 per cent) were male and 40 (13 per cent) were female; the mean age was 65·93 years. Participants were allocated to the treat-to-target group (145 participants) or the symptom-driven management group (163 participants). Remission during months 18–24 occurred more often in the treat-to-target group than in the symptom-driven management group (39·4 per cent [57 of 145 participants] vs 24·0 per cent [39 of 163]; absolute difference 15·4 percentage points. Adverse events occurred in 61 (42 per cent) participants in the treat-to-target group and 86 (53 per cent) in the symptom-driven management group (absolute difference –10·7 percentage points [95 per cent CI –21·8 to 0·4; p=0·060).
No serious drug-related adverse events and no treatment-related deaths were reported. The authors concluded that a treat-to-target strategy was associated with improved long-term disease control compared with symptom-driven care, without evidence of increased adverse events. They argue that their findings provide support for the use of systematic serum urate-guided urate-lowering therapy titration in the routine management of gout.
Pharmacists are core members of the healthcare team, offering essential support beyond dispensing of medications. They play a crucial role in managing and educating patients, particularly those with chronic diseases. Although numerous studies have reported the involvement of pharmacists in the care of people living with gout, the overall evidence remains limited and is not well defined.
This systematic review4 aimed to evaluate the impact of pharmacist-led interventions in improving gout outcomes in people living with gout, specifically focusing on serum uric acid levels, medication adherence, and patient education.
A comprehensive search was conducted on multiple electronic databases including PubMed, Ovid Embase and Cochrane (library) central to identify relevant studies published up to April 2025. The studies eligible for this review included randomized controlled trials (RCTs), and non-randomized studies (non-RCTs), including pre-post studies and cohort designs that assessed pharmacist-led interventions in the management of gout.
Outcomes of interest were reductions in serum uric acid levels, prevention of gout flares, absolute serum uric acid reductions, required dosage to achieve target serum uric acid level, improvements in patient education and frequency of clinic visits. The risk of bias for RCTs was assessed also. Five studies involving a total of 1,805 people living with gout were included in this review. In these studies, pharmacists delivered interventions such as provided interventions; enhancing patient education or providing pharmaceutical care either alone or in collaboration with other healthcare team members were included.
Two studies were RCTs, while three were non-RCTs. Pharmacist-led interventions contributed to achieving target serum uric acid levels, determining appropriate the dose of urate lowering therapy needed to attain target levels, improving adherence, and reducing gout flares. The randomized trials were found to have lower risk compared to non-randomized studies.
The authors concluded that pharmacist involvement in gout management can considerably enhance disease control and improve the overall quality of life for patients. Further research is warranted to identify the most effective components of pharmacist-led interventions and to evaluate their effect on gout outcomes. 
References:
- Mustafa M et al. Impact of lifestyle factors and dietary patterns on serum uric acid levels and disease activity in gout: a systematic review. Journal of Health, Population and Nutrition (2025) 44:223. https://doi.org/10.1186/s41043-025-00982-4
- Lu Y et al. Sugar-sweetened beverages and the risk of hyperuricemia and gout: a meta-analysis. Front. Nutr. 2025; 12:1669129. DOI: 10.3389/fnut.2025.1669129.
- Moses A et al. A treat-to-target strategy versus symptom-driven management of gout in the Netherlands (GO TEST Overture): a multicentre, open-label, pragmatic, superiority, randomised controlled trial. Lancet Rheumatology 2026 Volume 8, Issue 5e336-e345 (May 2026). DOI: 10.1016/S2665-9913(26)00034-2.
- Tanveer M et al. Effectiveness of pharmacist-led interventions in improving gout outcomes: A systematic review. Research in Social and Administrative Pharmacy 21 (2025) 975–990.