Patients are twice as likely to experience a gout attack overnight between the hours of midnight and 8 am than at other times of the day, according to a study published in Arthritis & Rheumatology. Some experts suggest optimizing preventive treatments, such as the timing of allopurinol and colchicines to possibly improve the situation. In the study, less than half of participants were taking either of these medications.
To assess the relationship between time of day and the risk for gout flares, researchers led by Hyon K. Choi, MD, DrPH, from Boston University School of Medicine, Massachusetts, prospectively recruited 724 patients with gout (mostly white males) and followed them for a year. The participants used the internet to report gout attacks and surrounding circumstances, including the date and time of flare up, symptoms, medication use, and other potential risk factors, such as alcohol or seafood consumption.
The risk for gout flares was 236% higher overnight than in the day, and 26% higher overnight than in the evening. The participants reported 1433 gout flares, of which 733 occurred in the overnight period.
Nighttime risk persisted even among patients who consumed no alcohol and low purine foods during the 24 hours before the attack. Most of the gout attacks occurred in the lower extremities.
The reasons for the increased risk are unclear, but possible causes include lower body temperature at night, dehydration in the joint due to sleep position or sleep itself, and a nighttime dip in cortisol levels.
A landmark study published online December 11 in Arthritis & Rheumatism by Hyon K. Choi, MD, DrPH, from Boston University School of Medicine, Massachusetts, and Sydney University, Australia, and colleagues confirmed the widely held assumption that gout is more likely to flare at night and challenged the common impression that attacks are more likely after alcohol or purine dietary indulgence.
Dr Choi, currently director of Clinical Epidemiology at Massachusetts General Hospital/Harvard Medical School in Boston, told Medscape Medical News that the 2.36-fold greater risk for nocturnal gout attacks has direct implications for clinicians treating patients with gout.