By kindlylives 
Many gout patients surely know well this sudden and intense pain at night. So, why does gout tend to flare up at night, and how should we deal with it?
1. High Uric Acid Concentration in the Blood
When the uric acid concentration in the blood is too high, tiny urate precipitates form in the joint cavity. This activates the body’s own immune system, triggering acute joint pain and causing a gout attack. At night, the body loses water through respiration, sweating, and urination. Unlike during the day, we can’t drink water at any time. As a result, the body is in a relatively dehydrated state. The blood becomes concentrated, the uric acid concentration rises, and more crystal precipitates form, which can trigger gout.
Coping Strategy: Drinking enough water is crucial for preventing gout attacks. Generally, it is advisable to drink a glass of water (300 – 500 milliliters) before going to bed. In summer when sweating is common or in winter when there is heating indoors, the water intake should be increased appropriately to ensure that the daily urine output is more than 2000 milliliters. Since drinking a large amount of water before going to bed can increase the frequency of getting up at night and affect sleep, gout patients need to strike a balance. Drink more water during the day, and avoid drinking too much water before going to bed or drinking water too close to bedtime. For gout patients, they should also avoid having a too – dry bedroom. A water cup can be placed beside the bed for easy access.
2. Low Hormone Secretion
Glucocorticoids in the human body can inhibit inflammation, effectively preventing gout attacks and relieving symptoms during an attack. However, the secretion of glucocorticoids has a distinct circadian rhythm. It is lowest from 0 – 2 am, starts to rise from 3 – 5 am, and reaches its peak at 6 – 8 am, and then gradually decreases. At midnight, due to reduced hormone secretion, gout has an opportunity to flare up.
Coping Strategy: Although we can’t change the body’s natural circadian rhythm of hormone secretion, exogenous hormones can be supplemented to prevent gout attacks and relieve symptoms. It should be noted that such medications have certain side – effects and potential risks in clinical use. Therefore, patients are not recommended to use them without permission. Patients can only use them under the guidance of a doctor when they have the indications for hormone treatment.
3. Relatively Low Body Temperature
When the body enters a sleep state, the metabolic rate slows down, the body temperature drops relatively, and the saturation of urate in the blood decreases. This makes it easier for crystals to precipitate and trigger gout.
Coping Strategy: Pay attention to keeping warm at night, especially at the distal parts of the limbs. In summer, don’t be too greedy for the cold, and the air – conditioner temperature should not be set too low. When using the air – conditioner, cover your feet with a thin blanket.
4. Reduced Blood Oxygen Concentration
Many gout patients are obese, and they often snore during sleep. Snoring can cause repeated apnea. In severe cases, it reduces the body’s blood oxygen concentration. To cope with hypoxia, the body will increase nucleoside metabolism, producing a large amount of endogenous purines. The end – product of purine metabolism is uric acid, which triggers gout.
Coping Strategy: Overweight and obese patients should actively lose weight. Gout patients with severe snoring should take measures to correct sleep apnea as soon as possible. They can choose to sleep in the lateral or semi – prone position, raise the head of the bed or the pillow to keep the nasal cavity unobstructed. Some patients can choose to wear an orthodontic device, undergo surgery, or receive other treatments to improve the impact of breathing on blood oxygen concentration.
In conclusion, to prevent nocturnal gout attacks, in addition to long – term adherence to a low – purine diet, moderate exercise, changing unhealthy lifestyles, and rational use of drugs to lower blood uric acid levels, targeted and effective interventions can also be carried out based on the four causes of nocturnal gout attacks.