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Journal of Peking University (Health Sciences) ›› 2023, Vol. 55 ›› Issue (5): 915-922. doi: 10.19723/j.issn.1671-167X.2023.05.021

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Diurnal differences in acute gout attacks: A clinical study of male gout patients

Hong DONG1,2,Li-min WANG1,Zhi-qiang WANG1,Yan-qing LIU1,Xiao-gang ZHANG1,Ming-ming ZHANG1,Juan LIU1,Zhen-bin LI1,*()   

  1. 1. Department of Rheumatology and Immunology, PLA Joint Logistic Support Force No.980 Hospital, Shijiazhuang 050082, China
    2. The Graduate School, Hebei Medical University, Shijiazhuang 050011, China
  • Received:2022-08-16 Online:2023-10-18 Published:2023-10-09
  • Contact: Zhen-bin LI E-mail:lizhenbin1962@126.com
  • Supported by:
    the Key Research & Development Project of Hebei Province(20377713D)

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Abstract:

Objective: To observe the diurnal difference of acute gout attacks in men, and provide reference for accurate clinical prevention and treatment. Methods: Using a single-center, cross-sectional study design, the patients diagnosed with gout in the outpatient department of Rheumatology and Immuno-logy of PLA Joint Logistic Support Force No.980 Hospital from October 2021 to April 2022 were selected. The information about the patient's current/last acute gout attacks (less than 2 weeks from visit), date and time of attacks, joint symptoms and signs, medication use, and relevant biochemical tests on the day of visit was recorded. The diurnal time difference of acute gout attacks in male patients was analyzed, and univariate comparison and multivariate Logistic regression analyses were conducted to compare the diurnal difference of acute gout attacks with clinical characteristics and biochemical indicators. Results: A total of 100 male gout patients were included, and 100 acute attacks were recorded. Diurnal distribution of acute gout attacks: morning (6:00~11:59, 18, 18%), afternoon (12:00~17:59, 11, 11%), the first half of the night (18:00~23:59, 22, 22%), the second half of the night (0:00~05:59, 49, 49%); During the day (included morning and afternoon, 29, 29%) and at night (included the first half of the night and the second half of the night, 71, 71%). The rate of acute gout attack was significantly higher at night than in the day (about 2.5 ∶1). No matter the first or recurrent gout, no matter the duration of the disease, the number of acute gout attacks had the difference of less in the day and more in the night. Serum urate (SU) level was higher in the patients with nocturnal attack than in those with daytime attack (P=0.044). Comorbidities were significantly different in the day-night ratio of the number of acute gout attack (P=0.028). Multiple Logistic regression analysis showed that SU level (OR=1.005, 95%CI: 1.001-1.009) and comorbidities (OR=3.812, 95%CI: 1.443-10.144) were the correlative factors of nocturnal acute gout attacks. Conclusion: No matter the first or recurrent gout, no matter the duration of the disease, it has a diurnal variation characterized by multiple attacks at night, increased SU level and comorbidities are correlative factors for nocturnal acute attack of gout.

Key words: Gout, Acute attack, Diurnal difference

CLC Number: 

  • R593.2

Figure 1

Flow diagram of gout cases screening"

Table 1

General clinical features of 100 male gout patients"

Items Day Night Total
Essential information
    Age/years, ${\bar x}$±s 36.97±11.84 36.71±13.02 36.78±12.62
    Course of disease/years, M (P25, P75) 2.00 (0.50, 4.00) 2.00 (0.67, 4.00) 2.00 (0.54, 4.00)
Medicationsa
    NSAIDs, n 2 8 10
    Febuxostat, n 10 37 47
    Allopurinol, n 0 3 3
    Benzbromarone, n 2 8 10
    Colchicine, n 1 1 2
    Hypotensive drug, n 1 6 7
    Hypoglycemic drug, n 1 2 3
    Unmedicated, n 6 22 28
Comorbidity
    Hypertension, n 1 6 7
    Coronary heart disease, n 0 2 2
    Hyperlipemia, n 11 34 45
    Liver injury, n 2 5 7
    Urolithiasis, n 1 4 5
    Renal inadequacy, n 0 2 2
    Diabetes, n 1 2 3

Table 2

Comparison of clinical related factors in gout patients who attacked at different times of day and night"

Correlative factors Day Night χ2 P
Disease course /year
    ≤1 9 19 0.187 0.666
    ＞1 20 52
Attacks, n
    First 4 17 1.279 0.258
    Recurrent 25 54
Comorbidity, n
    Yes 11 44 4.808 0.028
    No 18 27
Medication, n
    Yes 23 49 1.083 0.298
    No 6 22

Table 3

Comparison of biochemical indexes in gout patients who attacked at different times of day and night"

Items Day Night Z/t P
ESR/(mm/h), M (P25, P75) 5.0 (4.0, 7.0) 5.0 (4.0, 11.5) -0.340a 0.734
CRP/(mg/L), M (P25, P75) 2.49 (0.50, 10.66) 3.96 (0.50, 10.30) -0.049a 0.961
Urea/(mmol/L), M (P25, P75) 5.05 (3.88, 5.93) 4.60 (3.70, 5.50) -1.000a 0.317
Cr/(μmol/L), ${\bar x}$±s 78.75±11.27 81.52±13.37 1.052b 0.343
SU/(μmol/L), ${\bar x}$±s 450.54±128.35 503.85±107.96 1.049b 0.044*
Urinary pH, M (P25, P75) 6.00 (5.50, 6.00) 6.0 (6.0, 6.5) -1.655a 0.098
CHOL/(mmol/L), ${\bar x}$±s 4.70±0.95 5.06±1.13 2.805b 0.156
TG/(mmol/L), M (P25, P75) 1.70 (1.10, 2.46) 1.81 (1.34, 2.57) -0.339a 0.735
HDL/(mmol/L), ${\bar x}$±s 1.18±0.18 1.20±0.24 4.350b 0.598
LDL/(mmol/L), ${\bar x}$±s 3.07±0.64 3.41±0.88 5.091b 0.054
VLDL/(mmol/L), M (P25, P75) 0.79 (0.48, 1.12) 0.82 (0.58, 1.13) -0.173a 0.862

Table 4

Comparison between biochemical indexes at different stages of gout and diurnal differences in gout attack"

Items Day attacks Night attacks Z/t P
ESR/(mm/h)，M (P25, P75)
    Attack 6.5 (5.0, 15.5) 10.0 (4.0, 22.0) -0.433a 0.665
    Intermission 4.0 (3.0, 5.0) 5.0 (1.8, 6.0) -0.322a 0.747
CRP/(mg/L), M (P25, P75)
    Attack 7.87 (2.47, 14.85) 9.48 (2.65, 17.12) -0.298a 0.776
    Intermission 0.50 (0.50, 1.39) 0.50 (0.50, 3.82) -0.249a 0.803
Urinary pH
    Attack, M (P25, P75) 6.0 (5.5, 6.0) 6.0 (6.0, 6.5) -0.518a 0.605
    Intermission, ${\bar x}$±s 6.0±0.5 6.3±0.6 -1.873b 0.069
Cr/(μmol/L), ${\bar x}$±s
    Attack 79.38±10.58 82.38±13.94 -0.757b 0.453
    Intermission 77.92±12.57 80.59±12.89 -0.608b 0.547
Urea/(mmol/L), ${\bar x}$±s
    Attack 4.41±1.27 4.86±1.32 -1.147b 0.260
    Intermission 5.53±1.24 4.61±1.20 -2.279b 0.042*
SU/(μmol/L), ${\bar x}$±s
    Attack 488.13±126.21 515.39±107.22 -0.744b 0.464
    Intermission 400.42±117.97 490.72±109.17 -2.279b 0.034*
CHOL/(mmol/L)
    Attack, ${\bar x}$±s 4.57±1.00 5.18±1.13 -1.706b 0.095
    Intermission, M (P25, P75) 4.60 (4.25, 5.35) 5.07 (3.81, 5.59) 0.422a 0.673
TG/(mmol/L)
    Attack, ${\bar x}$±s 2.17±1.22 1.92±0.66 0.861b 0.394
    Intermission, M (P25, P75) 1.40 (1.08, 2.34) 5.07 (3.81, 5.59) -0.422a 0.673
HDL/(mmol/L), ${\bar x}$±s
    Attack 1.15±0.16 1.17±0.22 -0.337b 0.737
    Intermission 1.21±0.20 1.24±0.27 -0.148b 0.679
LDL /(mmol/L), ${\bar x}$±s
    Attack 2.98±0.73 3.47±0.92 -1.765b 0.085
    Intermission 3.17±0.52 3.32±0.83 -0.578b 0.567
VLDL/(mmol/L)
    Attack, ${\bar x}$±s 1.04±0.57 0.83±0.29 -0.357b 0.721
    Intermission, M (P25, P75) 0.64 (0.47, 1.10) 0.75 (0.52, 1.39) 0.274a 0.786

Table 5

Comparison between the biochemical indicators of different visit time and diurnal differences in gout attack"

Items Day attacks Night attacks Z/t P
ESR/(mm/h)，M (P25, P75)
    ＜1 week 6.0 (5.0，8.0) 5.0 (1.8，12.3) -0.636a 0.525
    1-2 weeks 4.5 (3.8，6.0) 5.0 (4.0，10.0) -1.092a 0.275
CRP/(mg/L), M (P25, P75)
    ＜1 week 8.13 (0.50，14.98) 6.02 (0.50，10.34) -0.189a 0.855
    1-2 weeks 1.93 (0.50，9.41) 3.68 (0.50，10.31) -0.204a 0.838
Urinary pH, M (P25, P75)
    ＜1 week 6.0 (5.5，6.0) 6.5 (6.0，6.5) -2.629a 0.011*
    1-2 weeks 6.0 (5.5，6.3) 6.0 (5.5，6.5) -0.200a 0.842
Cr/(μmol/L), ${\bar x}$±s
    ＜1 week 76.36±7.21 86.42±14.55 -0.439b 0.666
    1-2 weeks 80.29±13.25 79.31±12.35 -0.408b 0.685
SU/(μmol/L)
    ＜1 week, ${\bar x}$±s 466.36±59.57 486.32±111.11 -0.549b 0.587
    1-2 weeks, M (P25, P75) 382.00 (324.00，577.50) 502.00 (411.00，590.00) -1.985a 0.047*
CHOL/(mmol/L)
    ＜1 week, M (P25, P75) 4.56 (3.81，5.68) 5.52 (4.33，6.62) -1.463a 0.143
    1-2 weeks, ${\bar x}$±s 4.75±0.81 4.91±1.08 -0.537b 0.549
TG/(mmol/L)
    ＜1 week, ${\bar x}$±s 2.13±1.34 1.86±0.60 0.728b 0.473
    1-2 weeks, M (P25, P75) 1.70 (1.06，2.47) 1.78 (1.15，2.86) -0.368a 0.713
HDL/(mmol/L), ${\bar x}$±s
    ＜1 week 1.21±0.22 1.25±0.28 -0.436b 0.666
    1-2 weeks 1.15±0.15 1.18±0.23 -0.408b 0.685
LDL/(mmol/L)
    ＜1 week, M (P25, P75) 2.98 (2.58，3.83) 3.79 (2.80，4.54) -1.511a 0.131
    1-2 weeks, ${\bar x}$±s 3.10±0.45 3.28±0.83 -0.829b 0.411
VLDL/(mmol/L)
    ＜1 week, ${\bar x}$±s 0.97±0.65 0.86±0.27 0.612b 0.546
    1-2 weeks, M (P25, P75) 0.78 (0.51，1.12) 0.81 (0.46，1.18) -0.424a 0.672

Table 6

Multivariate Logistic regression analysis of the diurnal differences of acute gout attack"

Relevant factor Regression coefficient P OR 95%CI
Comorbidity 1.338 0.007 3.812 1.433-10.144
Serum urate 0.005 0.026 1.005 1.001-1.009
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