Initial attack: nocturnal?
My initial attack was nocturnal and there is ampleliterature references referring to the initial goutattack usually being a nocturnal one.
Does anyone have any idea as to WHY?
The feet would be dark and warm and if the person isasleep there would be no exercise induced enhancementof circulation.
But why nocturnal and why the feet, particularly thetoes?
Allen Aguada on June 28th, 2007
I read this is because feet swell up during normal activities of theday (by about half a UK shoe size - always buy shoes in theafternoon, never in the morning!)
The reverse of this happens overnight, (obviously - or your feetwould just keep getting bigger and bigger each day!) and happensquite rapidly, the swelling of a 16hr day goes down in about 2-3hours, hence the 2am anecdotal thing.
…so (locally) increasing the concentration/saturation levels ofuric acid - so precipitation and an attack is likely to occur.
Why the feet, especially the toes? Think it is simply an extremity,so more prone to heat loss - (a fluid is less able to hold a solutein solution as the temperature falls - precipitation again)
If it is simply ‘feet get cold’ why are gout sufferers never advisedto wear thick/warm socks in bed - not very sexy, but then again noris agonising pain!