Background Acute gouty arthritis is the inflammatory arthritis with abrupt and intermittent nature of attack.

Objectives The aim of this study was to analyze the seasonal variations of episodes of acute gouty arthritis.

Methods We searched MEDLINE, EMBASE, the Cochrane library, and KoreaMed for all articles published before November 2015. Studies with quantitative data on episodes of acute gouty arthritis by months and/or seasons were included. Meta-analysis for episodes of acute gouty arthritis was done by seasons and months. Subgroup analyses by the confirmatory methods of acute gouty arthritis were done by seasons.

Results Ten studies published between 1920 and 2015 were included, containing a total of 29,863 subjects. Plotting of episodes of acute gouty arthritis by months showed higher episodes during the period from March to July than other months. The risk ratio of episodes of acute gouty arthritis in spring was 1.21 (95% CI: 0.95 to 1.55, I²=86%; p=0.12), 1.32 (95% CI: 0.98 to 1.78, I²=90%; p=0.07), 1.27 (95% CI: 1.02 to 1.59, I²=81%; p=0.03) when compared to summer, fall and winter, respectively. Therefore, spring had significantly higher episodes of acute gouty arthritis than winter. Subgroup analyses by confirmatory methods of episodes of acute gouty arthritis were as follows: 1) The risk ratio of acute gouty arthritis confirmed by the presence of monosodium urate in synovial fluid in spring was 1.46 (95% CI: 1.22 to 1.76, I²=0%; p<0.0001), 1.28 (95% CI: 1.07 to 1.54, I²=7%; p=0.007), 1.24 (95% CI: 0.93 to 1.65, I²=59%; p=0.15) when compared to summer, fall and winter, showing that spring had significantly higher episodes of acute gouty arthritis than summer and fall; 2) The risk ratio of acute gouty arthritis confirmed by the presence of inflammation in synovial fluid was 1.53 (95% CI: 1.31 to 1.80, I²=0%; p<0.00001), 1.44 (95% CI: 1.07 to 1.93, I²=69%; p=0.02), 1.28 (95% CI: 1.05 to 1.55, I²=40%; p=0.01) when compared to summer, fall and winter, showing that spring had significantly higher episodes of acute gouty arthritis than 3 other seasons.

Conclusions This seems to be the first systematic review and meta-analysis on seasonal variations of acute gouty arthritis. Based on our study, the acute gouty arthritis might be developed more frequently during the period from spring. Increase in physical activity, dehydration, and seasonal variation of cortisol level could be related with this seasonal variation of episodes of acute gouty arthritis.

1. Choi HJ, Lee CH, Lee JH, Yoon BY, Kim HA, Suh CH, Choi ST, Song JS, Joo H, Choi SJ, Lee JS, Shin K, Jun JB, Baek HJ. Seasonality of gout in Korea: a multicenter study. J Korean Med Sci. 2015 Mar;30(3):240–4.

2. Elliot AJ, Cross KW, Fleming DM. Seasonality and trends in the incidence and prevalence of gout in England and Wales 1994–2007. Ann Rheum Dis. 2009 Nov;68(11):1728–33

Disclosure of Interest None declared