Emerging Microbiome Insights Suggest Novel Adjunct Targets in Gout Management

A recent narrative review synthesizes human and preclinical studies examining gut microbial features in gout and the potential role of prebiotics and probiotics in modulating disease pathways.

Across studies, patients with hyperuricemia and gout share a distinct microbial signature. The authors described the “gouty” microbiome as one marked by “reduced diversity, an elevated Bacteroides:Firmicutes ratio, and reduced presence of Akkermansia and Bifidobacterium.” These changes may influence urate metabolism, intestinal barrier function, and inflammatory signaling, although causal relationships remain uncertain.

Several preclinical models suggest that microbiome modulation can affect serum urate levels and inflammation. In anserine models, supplementation with Lactobacillus probiotic strains was associated with reductions in serum urate and hyperuricemia-driven inflammation. Murine studies further demonstrated that the chicory-derived prebiotic inulin may lower serum urate, while oral supplementation with the short-chain fatty acid butyrate reduced serum urate by enhancing urate excretion and alleviated tissue inflammation.

Despite these promising signals, the authors cautioned that the current evidence base has important limitations. Many studies included small sample sizes or lacked fully documented experimental controls. In animal models, translational relevance to human gout remains uncertain. The authors emphasized that “many of these studies are limited by modest numbers of participants and/or incompletely documented experimental controls,” and that geographic concentration of study populations further constrains generalizability.

For rheumatologists, the key takeaway is that while microbiome-directed interventions are not ready for routine clinical use, emerging data highlight a potential mechanistic link between gut ecology and urate homeostasis. These findings may help explain interindividual variability in disease severity and response to therapy.

The authors concluded that there is “a need for more information regarding the features of the ‘gouty’ microbiome in wider populations,” along with well-controlled probiotic and prebiotic studies in physiologically relevant models before advancing to human trials. Until then, microbiome-based strategies should be viewed as investigational adjuncts rather than replacements for evidence-based gout therapies.

Reference
Renton N, Pillinger MH, Toprover M. Gout, hyperuricemia, and the intestinal microbiome. Inflammation. 2025;48(6):3776-3784. doi:10.1007/s10753-025-02337-x