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Gout attacks ‘twice as likely at night as during the day

People with gout are significantly more susceptible to flare-ups of their condition at night than during daylight hours, a new US study has shown. Led by Boston University School of Medicine and published in the medical journal Arthritis & Rheumatology, the research utilised data from the Boston Online Gout Study – which investigated triggers for gout attacks from 2003 to 2013 – to see when these attacks were most prevalent.

A total of 724 gout patients were recruited and followed for one year, providing dates and hours for when gout attacks occurred, as well as answering questions on 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. Findings indicated that participants experienced 1,433 gout attacks during the study period. Of these, 733 were recorded between midnight to 07:59, 310 were between 08:00 and 14:59, and 390 took place between 15:00 to 23:59.

This means the risk of a gout flare was 2.4 times higher overnight and 1.3 times higher in the evening compared to daytime hours. This trend persisted even among those with no alcohol intake and low purine intake during the 24 hours prior to the attack, and after accounting for gender, age, body mass index and use of various medications. Lead author Dr Hyon Choi, a former Boston University researcher who is currently at Massachusetts General Hospital and Harvard Medical School, said: “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. As a result of our study, prophylactic measures that prevent gout flares, especially at night, may be more effective.”

A spokeswoman for Arthritis Research UK welcomed the findings as clinically useful, adding: “It could be that people at risk of gout attacks are more dehydrated at night, because they may have eaten a rich meal with red wine or drunk alcohol in the evening and this has a knock-on effect, causing a flare-up.

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