All About Gout – Symptoms, Diagnosis, Treatment


Why Flare-Ups Happen at Night

It is not uncommon for gout to flare-up in the middle of the night, waking a person from a sound sleep. One research study of more than 700 gout patients found that flare-ups were 2.4 times more likely between midnight and 8 am than between 8 am and 4 pm.

Researchers theorize gout attacks often occur at night because:

  • Uric acid is more likely to form crystals at lower temperatures. The body’s temperature drops slightly during sleep, encouraging the formation of crystals.
  • Breathing rates slow down during sleep, and the lungs expel less carbon dioxide. Excess carbon dioxide can cause the blood to become slightly more acidic. This condition, called respiratory acidosis, may encourage the formation of uric acid crystals.
  • People with sleep apnea take in less oxygen, which can lead to an increase in the body’s production of purines and cause hyperuricemia.
  • The body’s cortisone levels tend to dip while sleeping. Cortisone suppresses inflammation, and a dip in cortisone may contribute to gouty inflammation.
  • Overnight dehydration may facilitate hyperuricemia and/or increase the concentration of crystals in the joint fluid.

More research is needed in this area.

Gout Attack vs. Chronic Gout

It is possible to have a gout flare-up and never experience another. Repeated instances of acute gout are called chronic gout

The treatment goals for a gout attack are different than those for chronic gout. When treating a gout attack, the goal is to relieve pain and inflammation. When treating chronic gout, the goal is to prevent future gout attacks and long-term joint damage.

While some people with chronic gout may get frequent gout attacks, others may have years in between attacks. If chronic gout is not treated, attacks may become more frequent and/or last longer.

Left untreated, a gout attack will usually resolve itself within a few days or weeks. Chronic gout can permanently damage a joint’s tissues and decrease its range of motion. For this reason, it is important to recognize symptoms, understand risk factors, get an accurate diagnosis, and treat and prevent gout.


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