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Gout attacks are twice as likely during the night as in the day, Arthritis & Rheumatism reports, which could influence the timing of medication, especially for drugs with short half-lives. Researchers enrolled 724 gout patients who experienced 1,433 attacks. The authors divided the day into eight-hour blocks. Attacks were 2.36 times commoner from 00:00-07:59 (51.2 per cent of attacks) than between 08:00 and 15:59 (21.6 per cent). Attacks were 1.26 times commoner between 16:00-23:59 than during the day. The nocturnal pattern persisted in various sub-groups stratified according to purine intake, sex, age, obesity and use of alcohol, diuretics, allopurinol, colchicine and NSAIDs. Lower body temperature, night-time dehydration or a nocturnal dip in cortisol levels may contribute to the peak in gout attacks. “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,” says lead author Hyon Choi from Harvard Medical School.  “As a result of our study, prophylactic measures that prevent gout flares, especially at night, may be more effective.” (DOI 10.1002/ art.38917)