Hyperuricemia and Gout: Ancient Ailments’ Advanced Approaches (A Narrative Review)

Hyperuricemia (HUA) and gout are evolving global health challenges, transitioning from localized joint pathologies to recognized systemic metabolic disorders. While traditionally associated with the appendicular skeleton, emerging evidence highlights a profound “extra-articular” burden affecting multiple organ systems. Although uric acid (UA) is often marked by its adverse effects, it exhibits significant physiological roles, including neuroprotective antioxidant properties. Comorbidities and systemic involvement are intertwined with HUA. Various factors contribute to the development of HUA, but there are options for reducing serum UA levels. The pathophysiology of HUA can be categorized into overproduction, underexcretion, and combined mechanisms, emphasizing that precision in subtyping is critical for optimizing pharmacological efficacy. Furthermore, this review analyzes the shifting paradigm in dietary management and the complexities of treating multi-system comorbidities related to HUA. We summarize the pathology and consequences of HUA and gout, alongside assessment strategies, investigations outline, differentials search, and evidence-based management protocols.