Why does a gout attack often occur at 4 AM?

Gout attacks often occur at night or in the early morning due to a combination of physiological factors occurring at that time of day.

At night, your body temperature drops. Because gout is caused by the formation of uric acid crystals in your joints, a lower temperature can promote the formation of these crystals. Joints such as your toes are more sensitive to a drop in temperature, which causes uric acid to crystallize more quickly and cause inflammation.

During the night, you consume less fluid, and you can lose fluid through sweating. This can lead to an increased concentration of uric acid in your blood, which increases the risk of crystal formation and a gout attack. Dehydration makes it harder for your body to eliminate excess uric acid.

During the night, levels of the hormone cortisol, which has an anti-inflammatory effect, drop. Low cortisol levels make your body more susceptible to inflammation, such as that caused by uric acid crystals in your joints. This can make an early morning gout attack more intense.

When you sleep, your blood circulation slows down. This can lead to slower removal of uric acid from the blood and joints, increasing the chance of crystal formation.

Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4360969/

Author: Prof. Dr. Dirk Devroey - Latest update: 2024-09-08 - Copyright: Clinifacts 2025