方法：我们设计了病例交叉对照研究研究急性痛风发作与时间的关系。通过因特网招募并追踪痛风患者一年。参与者需回答以下问题，在痛风发作时：发作时间，症状和征象，用药和痛风发作前24小时及48小时所谓的风险因素情况。根据一天3个8小时并使用条件logistic计算痛风发作的风险比(比如00:00-07:59, 08:00-15:59, 和16:00-23:59)
附原文：Background: Several plausible mechanisms and anecdotal descriptions suggest that gout attacks often occur at night; however, no scientific data are available.Methods: We conducted a case-crossover study to examine the risk of acute gout attacks in relation to time of the day. Gout patients were prospectively recruited and followed via the Internet for one year. Participants were asked about the following information when experiencing a gout attack: the date and hour of attack onset, symptoms and signs, medication use, and purported risk factors during the 24 and 48 hour periods prior to the gout attack. We calculated the odds ratio (OR) of gout attacks according to three 8-hour time blocks of the day (i.e., 00:00-07:59, 08:00-15:59 [reference], and 16:00-23:59 hours) using conditional logistic regression.Results: Our study included 724 gout patients who experienced a total of 1433 attacks (733, 310, and 390 attacks during the first, second, and third 8-hour time blocks, respectively) over one year. The risk of gout flares in the 8-hour block overnight (00:00-07:59 hours) was 2.36 times higher than in the daytime (08:00-15:59 hours) (OR = 2.36, 95% CI: 2.05 to 2.73). The corresponding OR in the evening (16:00-23:59 hours) was 1.26 (95% CI: 1.07 to 1.48). These associations persisted among those with no alcohol use and in the lowest quintile of purine intake in the 24 hours prior to attack onset. Furthermore, these associations persisted in subgroups according to sex, age group, obesity status, diuretic use, and use of allopurinol, colchicine, and non-steroidal anti-inflammatory drugs.Conclusions: These findings provide the first prospective evidence that the risk of gout attacks during the night and early morning is 2.4 times higher than in the daytime. Further, these data support the purported mechanisms and historical descriptions of the nocturnal onset of gout attacks and may have implications for anti-gout prophylactic measures. © 2014 American College of Rheumatology.
引自：Hyon K. Choi, JingboNiu, TuhinaNeogi,et al.Nocturnal risk of gout attacks.Arthritis & Rheumatology.Published online December 11, 2014.