New Zealand workers continue to be at the forefront of gout research and have participated in the recent European League Against Rheumatism/American College of Rheumatology (EULAR/ACR) revision of gout classification criteria [
11], identification of genetic predisposition markers [
12], clarification of environmental triggers, imaging features and identification of optimal approaches to management as summarized recently by Dalbeth et al. [
13]. What are some of the important advances? Dual energy computed tomography (DECT) has provided new insights into the nature of this crystal deposition disease by allowing direct visualization of urate deposits in many patients with tophaceous gout and some with asymptomatic hyperuricaemia [
14]. The diagnostic role of ultrasound in gout has also recently been studied [
15], and this modality was found to have high specificity, even in those with early disease without obvious clinical features. An important environmental trigger is the excessive consumption of sugar-sweetened beverages (SSB), which contain high levels of fructose. As developed countries face skyrocketing levels of obesity and type II diabetes, there has also been an increase in gout, and SSB consumption is likely to be an important precipitant, especially in peoples of Polynesian origin who have inherently raised urate levels due to genetic factors [
12]. Unfortunately, a recent study indicates that a high proportion of patients with gout and type II diabetes, including those on haemodialysis, are not responding to health messages to abstain from SSB consumption [
16]. Advances in urate-lowering therapy (ULT) include a re-assessment of the place for older drugs such as benzbromarone and allopurinol [
13]. A recently completed randomised controlled trial in gout all-comers (including those with renal disease) compared a dose-escalated regimen of allopurinol (up to 600 mg/day) with controls dosed traditionally according to creatinine clearance [
17]. Target serum urate (<6 mg/L) was achieved at month 12 in 69% of the dose-escalated participants vs 32% of controls (
p < 0.001) without added toxicity in this challenging group of gout patients. Febuxostat is another extremely effective agent in this setting and available in New Zealand for patients who have not responded to first-line ULT.