A study published online in December in Arthritis & Rheumatology says 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. The study confirms that nocturnal attacks persist 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, according to a news release.
The American College of Rheumatology estimates that more than 8.3 million Americans suffer from gout making it the most common inflammatory arthritis in the U.S., according to the release.
Acute gout flares are triggered by the crystallization of uric acid within the joints. It is speculated that lower body temperature, nighttime dehydration or a nocturnal dip of cortisol levels may contribute to the risk of gout attacks at night, lead author Hyon Choi, MD, DrPH, Massachusetts General Hospital/Harvard Medical School (formerly at Boston University School of Medicine), said in the release. Despite the possibility of a nighttime 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 Boston Online Gout Study investigated triggers for gout attacks from 2003 to 2013 in 724 gout patients who were followed for one year. Participants were asked to provide the date and hour that a gout attack occurred, and 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 old. During the gout flare or the time between attacks, about 68% of subjects consumed alcohol, 29% took diuretics, 45% used allopurinol, 54% used nonsteroidal anti-inflammatory drugs and 26% took colchicine, according to the release.
Findings indicate that participants experienced 1,433 gout attacks 733 in the overnight hours (midnight to 7:59 a.m.), 310 in the daytime (8 a.m. to 2:59 p.m.) and 390 in the evening (3 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.
Researchers also found that this 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 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, Choi said in the release. As a result of our study, prophylactic measures that prevent gout flares, especially at night, may be more effective.
To read the abstract, go to http://onlinelibrary.wiley.com/doi/10.1002/art.38917/abstract;jsessionid=F377BD03A558E435E1D67D52BE10FCD9.f03t02