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Gout attack risk twice as likely at night

Research finds risk of gout attacks more than doubles during the night or early morning hours

Ingrid Torjesen

Thursday, 11 December 2014

The risk of acute gout attacks is more than two times higher during the night or early morning hours than it is in the daytime, according to the findings of novel research* published in the journal Arthritis & Rheumatology.

The higher risk of nocturnal attacks persists even among those who did not consume alcohol and had a low amount of purine intake during the 24 hours prior to the gout attack.

"It is speculated that lower body temperature, night-time dehydration, or a nocturnal dip of cortisol levels may contribute to the risk of gout attacks at night," explains lead author Dr Hyon Choi, from Massachusetts General Hospital/Harvard Medical School. "Despite the possibility of a night-time link to gout, no study prior to our current investigation has looked at the association between gout attack risk and the time of day."

The research team recruited 724 gout patients in Boston who were followed for one year via the internet. Participants were asked to provide the date and hour that a gout attack occurred, as well as to answer questions about their symptoms, medication use, and certain risk factors (such as alcohol use and seafood consumption) during the 24 and 48 hours preceding the gout flare.

On average, participants were 54 years of age and were primarily white (78%) men (89%), and more than half were college educated. Preceding the gout flare, roughly 68% of subjects consumed alcohol, 29% took diuretics, 45% used allopurinol, 54% used nonsteroidal anti-inflammatory drugs (NSAIDs), and 26% took colchicine.

Participants experienced a total of 1,433 gout attacks: 733 in the overnight hours (midnight to 7:59 a.m.), 310 in the daytime (8:00 a.m. to 2:59 p.m.), and 390 in the evening (3:00 p.m. to 11:59 p.m.) during the one-year study period. The risk of a gout flare was 2.4 times higher overnight and 1.3 times higher in the evening compared to daytime hours.

Furthermore, the researchers found that this higher nocturnal risk persisted even among those with no alcohol intake and low purine intake during the 24 hours prior to the gout attack. These associations remained after accounting for sex, age, body mass index (BMI), and use of diuretics, gout medications, and NSAIDs.

"Our findings provide the first prospective evidence that the risk of gout flares is higher during the night and early morning hours than during the day," Dr Choi said.

* Hyon K. Choi, et al. Nocturnal risk of gout attacks. Arthritis & Rheumatology, 2014. doi: 10.1002/art.38917

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