Gout: one year in review 2026

The year 2025 marked a significant evolution in the understanding and management of gout, characterised by a growing focus on personalised medicine and multidimensional pathogenetic models.This review provides a comprehensive analysis of the scientific literature published during 2025, highlighting key advancements across several fields. Specifically, we discuss emerging epidemiological trends, such as the rising incidence of early-onset gout, and the integration of artificial intelligence into diagnostic imaging. Groundbreaking genetic studies are explored, identifying early-onset disease as a potentially distinct subset, alongside new insights into the 'gut-kidney axis' and the role of the microbiome in urate homeostasis.Furthermore, this review examines updated pathogenetic mechanisms involving immunometabolic reprogramming and evaluates the latest therapeutic strategies for both gouty arthritis and asymptomatic hyperuricaemia.