Many people with gout know what it’s like to be awakened at 3 am with the excruciating pain of a gout flare. But why do gout attacks happen at night? Dr. Hyon Choi, Director of Clinical Epidemiology at Massachusetts General Hospital, led an internet-based study a few years ago hoping to find the answer to this question.1 Read on to learn more about what Dr. Choi and his team discovered.
The relationship between uric acid and gout2
Uric acid is a waste product made by the body as it breaks down purines (purines are natural substances found in the cells of the body and in some foods). When the amount of uric acid in the bloodstream reaches a certain level, urate crystals can begin to form around a joint. Eventually, the crystals in the joint can cause the sudden and intense pain, redness and swelling you may know as a gout flare.
Dr. Choi and his team recruited 724 gout patients (89 percent men; average age: 54 years old) and tracked them for a year via the internet. Participants were asked to record the date and hour they had a gout attack, as well as answer questions about their gout symptoms, the medications they were taking and gout flare risk factors (including alcohol and seafood intake) during the 24 and 48 hours prior to the gout flare.
Study findings showed that participants experienced a total of 1,433 gout flares during the course of the one-year study.1 The results also found that the risk of a flare was 2.4 times higher overnight and 1.3 times higher in the evening than the risk of a flare during the day.1 This was true for participants regardless of their gender, age, weight, medication use or diet.1
Time of Day1
Number of Gout Flares1
8:00 am to 2:59 pm
3:00 pm to 11:59 pm
12:00 am to 7:59 am
So now that we have reviewed evidence suggesting that gout flares are more likely to happen at night1, the question remains: “Why do gout attacks happen at night?” Researchers suspect a few culprits:
Lower body temperature1
For most people, body temperature falls from about 99.5 degrees F (37.5 degrees C) during the day (10:00 am to 6:00 pm) to about 97.5 degrees F (36.4 degrees C) during the late night/early morning hours (2:00 am to 6:00 am). This decrease in body temperature may promote the formation of urate crystals, potentially triggering a gout flare.
Even if you stay hydrated during the day, you can lose some of your body’s fluids just by breathing while you sleep.3 And if you snore or have sleep apnea, you can lose even more.3 The same is true if you hit the sack in a toasty or overly dry bedroom.3 This nighttime dehydration is believed to contribute to the higher risk of gout flares during the late night/early morning hours.1
Falling cortisol levels
The dip in cortisol levels that typically happens between midnight and 4 am can also contribute to your risk of gout flares.1 Cortisol is a hormone made by your adrenal glands that affects many of your body’s functions.4
Gout flare prevention is key
Regardless of the time of day, most people would do anything to avoid the pain of a gout flare. Fortunately, gout flares may be prevented with medication.5 One such gout medication, Mitigare® (Colchicine) 0.6 mg Capsules, is FDA-approved to help prevent gout flares in adults.5 The safety and effectiveness of Mitigare® for acute treatment of gout flares during prophylaxis has not been studied. Mitigare® is not an analgesic medication and should not be used to treat pain from other causes. To learn more about Mitigare® and how it may be able to help you prevent gout flares, talk with your doctor.5
Important Safety Information
Colchicine 0.6 mg capsules are contraindicated in patients with renal or hepatic impairment who are currently prescribed drugs that inhibit both P-gp and CYP3A4. Combining these dual inhibitors with colchicine in patients with renal or hepatic impairment has resulted in life-threatening or fatal colchicine toxicity. Patients with both renal and hepatic impairment should not be given Mitigare®.
Fatal overdoses have been reported with colchicine in adults and children. Keep Mitigare® out of the reach of children.
Blood dyscrasias such as myelosuppression, leukopenia, granulocytopenia, thrombocytopenia, and aplastic anemia have been reported with colchicine used in therapeutic doses.
Monitor for toxicity and if present consider temporary interruption or discontinuation of colchicine.
Drug interaction with dual P-gp and CYP3A4 inhibitors: Co-administration of colchicine with dual P-gp and CYP3A4 inhibitors has resulted in life-threatening interactions and death.
Neuromuscular toxicity and rhabdomyolysis may occur with chronic treatment with colchicine in therapeutic doses, especially in combination with other drugs known to cause this effect. Patients with impaired renal function and elderly patients (including those with normal renal and hepatic function) are at increased risk. Consider temporary interruption or discontinuation of Mitigare®.
The most commonly reported adverse reactions with colchicine are gastrointestinal symptoms, including diarrhea, nausea, vomiting and abdominal pain.
NOTE: This article was not written by a medical professional and is not intended to substitute for the guidance of a physician. These are not Hikma’s recommendations for gout flare prevention, but rather facts and data collected from various reliable medical sources. For a full list of resources and their attributing links, see below.