Hyperuricaemia and gout in the Pacific.

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.