Abstract
Gouty arthritis is a crystal-induced inflammatory disease driven by hyperuricemia and monosodium urate (MSU) crystal deposition. Although pharmacological urate-lowering and anti-inflammatory therapies are effective, adverse effects, poor adherence, and recurrent flares remain important challenges. Functional foods and food-derived bioactive compounds have therefore attracted interest as adjunctive strategies targeting uric acid (UA) metabolism and inflammation. In this review, we synthesize current mechanistic, preclinical, and clinical evidence on how functional foods and bioactives may modulate gout pathogenesis, with attention to translational limitations and precision nutrition opportunities. The reviewed evidence focuses on functional food effects on urate production, urate transport, MSU-induced inflammation, oxidative stress, and gut microbiota-related pathways. Key molecular targets include xanthine oxidoreductase, urate transporters such as URAT1, GLUT9, OAT1/OAT3, and ABCG2, NLRP3 inflammasome signaling, and microbiota-derived metabolites. Flavonoids, polyphenols, probiotics, omega-3 fatty acids, and dietary fibers show potential anti-hyperuricemic and anti-inflammatory activities through xanthine oxidoreductase inhibition, regulation of renal and intestinal urate transporters, suppression of NLRP3 inflammasome activation and IL-1β release, attenuation of oxidative stress, and modulation of gut microbiota composition and short-chain fatty acid production. However, current evidence remains dominated by in vitro and animal studies, while clinical translation is limited by variable bioavailability, dose discrepancies, food matrix effects, formulation heterogeneity, and insufficient randomized controlled trials. Functional foods may complement established gout management by targeting interconnected metabolic and inflammatory pathways. Future studies should prioritize standardized formulations, pharmacokinetic evaluation, genotype-informed responses involving ABCG2 and SLC2A9, and clinically meaningful outcomes such as serum urate, flare frequency, pain, physical function, and quality of life.
