How does weather affect Rheumatoid Arthritis?

Whether or not weather affects Rheumatoid arthritis has been a hotly debated topic for a long time. Right from the time of Hippocrates, it has been believed that pain in rheumatic diseases is affected by external environmental exposures. Many of my patients keep telling me that weather affects their arthritis on a regular basis. Most of them complain that cold or damp weather & rains make them feel worse than sunnier, warmer, drier weather. Many of our RAers have been mentioning the effect of weather on their blogs RA Guy’s blog . The About.com poll has 5600 votes with 75% saying weather affects their arthritis. Sixty percent of subjects in a study by Drane D & colleagues reported that they were sensitive to weather. Thus, the effect of weather on arthritis seems to be very much true from the RAer’s perspective.

However, if we look at the scientific literature & data, there is no consensus on the existence of this association. Nor is there any scientific explanation for this possible association. The scientific community has been trying to explore this association for a long time now.

In 1961, a famous arthritis specialist, J. Hollander M.D., conducted a study in which he built a climate chamber and demonstrated that high humidity combined with low barometric pressure were associated with increased joint pain and stiffness.

Gorin AA & colleagues studied 75 RA patients who recorded their pain for 75 consecutive days. The recordings were then correlated with objective weather indices including temperature, barometric pressure, relative humidity, and percentage of sunlight for those days. Pain levels were highest on cold, overcast days and following days with high barometric pressure & humidity. Some patients were more weather sensitive than the others.

Strusber I & Aikman H studied the effect independently & found that low temperature, high atmospheric pressure, and high humidity did correlate with joint pain & stiffness in RA.

Wiebe R. Patberg studied all the studies published between 1985 to April 2003 & found that temperature and humidity do appear to have clear influences on the symptoms of RA. He concluded that the classic opinion that “Cold and wet is bad, warm and dry is good for RA patients,” seems to be true only as far as humidity is concerned.

How humidity affects the arthritic pain is difficult to understand. The skin is impervious to the moisture & most people remain indoors during the rains. A warm shower does not generally increase the joint pain/ stiffness. The incidence of RA is not different in dry & rainy locations around the globe & not all patients who move to drier areas experience remission.

Theories have been proposed to explain the effect of the drop in air pressure. The drop in barometric pressure that accompanies cold, rainy weather allows tissues in the body to expand to fill up the space. The inflamed synovium is hypothesized to swell & cause more pain. Another explanation is that damp & cold weather causes the muscles to shiver to maintain body temperature thereby producing traction on the joints causing pain.

Other Investigators have not found any significant association between weather & joint pain. They feel the association is ‘all in the head’. Reasons cited include a drop in the pain threshold during the rains. Even amputees have been found to have an increase in the phantom limb pain during the rains. Other factors that may affect the pain include the mood changes with rainy/ cold season & the fact that such weather forces RAers to remain indoors & hence increase the pain & stiffness.

So then, what is the bottom line?

Weather, especially rainy & cold weather does seem to increase the joint pain & stiffness in RAers. This may not be true for every RAer; but does happen in many RAers.

References:
The association between external weather conditions and pain and stiffness in women with rheumatoid arthritis. Drane D, Berry G, Bieri D, McFarlane AC, Brooks P. J Rheumatol. 1997 Jul;24(7):1309-16.

Rheumatoid arthritis patients show weather sensitivity in daily life, but the relationship is not clinically significant. Gorin AA & colleagues. Pain. 1999 May;81(1-2):173-7.

Influence of weather conditions on rheumatic pain. Strusberg I, Mendelberg RC, Serra HA, Strusberg AM. J Rheumatol. 2002 Feb;29(2):335-8.

The association between arthritis and weather. Aikman H Int J Biometeorol. 1997 Jun;40(4):192-9.

Weather Effects in Rheumatoid Arthritis: From Controversy to Consensus. A Review W R. Patberg, J J Rasker J Rheumatol 2004;31:1327-34

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25 Responses to How does weather affect Rheumatoid Arthritis?

  1. Chelsea says:

    Good, comprehensive post Dr. Akerkar! Yes, we all believe it does affect us. I have thought for years that although not feasible, if they could give us all MRI scans before, during, after weather changes they would see changes, probably even in bone marrow edema. The comment on muscle shivering during cold putting pressures on the joints is not one I’d clarified in that manner in my mind, but is like an aha! moment for me for my own joints, and I see/feel it happen in my relative’s hemiplegic leg and arm during cold versus hot weather all the time when trying to assist in moving from chair to car/bed/bath, etc. Thanks for doing a post on this!

    • Though we do not have scientific evidence, this interaction is definitely real. The best way to take prevent the flare is to keep the RA under check. Well controlled RA is less affected by changes in weather.

  2. Iris Carden says:

    Don’t know about RA – but weather certainly affects lupus – joint pain in cold weather and fatigue in hot weather! (I feel like I can’t win either way.)

  3. barbara johnson says:

    thank you for this article… may i add that on the day of a recent “hurricane” here in New England… i felt horrible… fluelike, sleepy and achey….. so for me the weather does make the difference… as well, though i find it interesting that the “hot tub” here where i live feels like “heaven on earth”…:)… so that is a contradiction… perhaps the barometric pressure does effect!
    barbara

    • This definitely has an explanation, Barbara.

      When a weather front is moving through an area, it is preceded by a wave of positive ions in the surface air.
      Patients often report that they can sense changes in the air hours or days before a front approaches. The pain typically increases when the front is approaching, and reaches a maximum when the patient is situated at or near the center of the front.

  4. Thanks for this post, I also have an arthritis and this will surely help.

  5. poornima ambli says:

    Delhi cold weather does’nt affect me but yes the damp weather & rain make me feel worse than dry weather especially when I visit places like Belgaum !

  6. I_don't_miss_high_heels says:

    I agree with, when autumn sets in I start to feel more achey and stiff and therefore just a little bit more miserable as i know the coming months won’t be as easy as the summer….

    But i also wonder how depression/SAD affects me also as don’t we all feel happier in general when the sun is shining, and a positive outlook helps us in many ways.

    Anyway, to make my point: I think my RA is better in the summer because I am happy (warm, sunny, fun things to do) and in the winter not so much…. :)

  7. Danice says:

    thank you for this post Dr. Akerkar! I am one of the RA’ers who can correlate increased pain with weather changes. A cold front moved in last night & most of my joints were in the 9 on pain scale (even with pain meds), some went above 10. Even in the summer, we have lots of humidity here, it is unbearable to be outside or in any kind of non-temperature/humidity controlled room bc of the pain and fatigue. Winters can be really cold rainy & unbearable; summers are hot humid and unbearable- that leaves me 2 seasons where the weather is not a factor, most of the time ;)
    Honestly, I don’t think that SAD/depression plays a role in this- i have been dealing with this for over 9 years and while mood can affect some people’s pain levels, I have been through therapy etc to cope with various issues and consider the weather to be a genuine factor in affecting pain.
    I hope this isn’t too confusing – and I have explained it well- Regardless, thank you for your wonderful work as a rheumatologist and as a truly empathetic doctor.

    • Dear Danice,

      It is not confusing & you have put forth the point very well.

      As a student, I always believed the books & always thought that this ‘weather- flare connection’ is all ‘in the mind’
      However, as a Rheumatologist, I am convinced that this does happen. We need to find out the science behind it.

      • Ruth Loeffler says:

        Hello,
        I have RA and I know weather certainly affects pain level!!! I live in Northern Ohio. Sometimes, I wake up from pain. Then, I feel the cold temperature, or see how gray it is outside. I do not know much about barometric pressure, but sunny warm days are easier. Sometimes I go to Costa Rica and life is easier there. It is not in the head! It really hurts much more in the fall and the winter and most of the spring. I have been in Ohio for 20 yrs but I am from Costa Rica. Now in my 50s I know I will not live here more than a few yrs due to weather. I hope some rheumatologists who experience RA can be a testimony for this issue. How can a dr tell us that it is in the head?? I tell you, it is in the joints!!! By the way, I am a mental health professional and I know I do not imagine more pain specially before my mind is totally awake in the mornings!
        Thanks for sharing. Thanks for listening.
        Many blessings.
        Ruth

  8. baryjazz says:

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  9. Eamon says:

    Just came across this blog when when searching RA. What has been said about the weather is correct. My mother suffers sevrly when the weather changes. I had juvenile RA when I was younger to the degree I would be awake all night. I had nothing else to do but learn form it. As I grew older I learnt to deal with the pain to the degree that I no longer suffered from it. I am not aware of my dietary change when I was younger but it is possible. However the one thing I did learn is that the pain came prior to a major weather change and intensified during extreme pressure high and lows. I found the weather was not the problem but the climatic change, whether it is electrostatic or otherwise I do not know. There was a saying in Ireland that elderly people said when the weather was going to change “I can feel it in my bones”, They were always right prior to a big storm coming in. It may be a similar recognition to when dogs start howling prior to a storm. It would be great if there was greater study carried out, which if confirmed – micro climatic changes could be made within a building could release suffers from pain rather than the use of heavy medication. Positive and negative ions, these too may be a factor. Keep up the great work.

    • Ruth Loeffler says:

      Nice to hear about other people’s experiences. We all who have commented here do experience something that science has not caught up with “data”. We know IT IS SO, as someone commented above “we feel it in the bones” meant literally, no esoterically!

      • Eamon says:

        Yes, Ruth I have to agree science has not caught up yet, however technology has in a way. One tool I used when I was young was a very hot water bottle (rubber) which I alternated between arms and legs when the intensity was too much. Nowadays the are products sold not as a solution to medical conditions but as a solution to humidity. One real product that works is a solar air collector – otherwise known as a Solarventi. This will create positive pressure internally using dry hot air. This in turn reduces humidity and increases heat, but also (unproven) changes the internal environmental conditions.
        As a past JRA sufferer, I certainly believe it will make a huge difference to everyday life for people living with similar conditions, without the need for excessive medication. There are similar products in Germany, Canada and USA. However the product I mentioned can be found at http://www.solarventi.com .

      • Ruth Loeffler says:

        Thanks so much for the information! I have RA, Osteo A and fibromyalgia. Now plantar faciitis in one foot.
        I do yoga, meditation, reiki, get acupunture, listen to soothing music, use biofreeze gel, get massages and all helps. A friend just told me about the effectiveness of magnesium chloride. I also take curcuma (reduces inflammation) glucosamine and chondroitin and a multivitamin I.at everyday raw garlic (reduces inflammation)
        I use affirmations, I trained as a yoga teacher and reiki master as well as am training to be a hypnotherapist. I am a mental health counselor (not working right now). So, I applied all of these healing practices on myself. I think they all help but sometimes, when the weather does not help, I take a pain pill rx by rheumatologist who often tries to give me Cymbalta, lyrica, tramadol, etc. But I avoid them. I also do not eat meat, drink alcohol (only on special occasions) and do not smoke.
        Many blessings.

  10. Hi there! I could have sworn I’ve been to this blog before but after browsing through some of the post I realized it’s new to me.
    Anyways, I’m definitely happy I found it and I’ll be
    book-marking and checking back frequently!

  11. gayle says:

    I typed in r.a. and humidity this morning as I am in so much pain and it has been humid for 4 or 5 weeks now. it is a comfort to see that this is not all in my head. I am going to keep following this site. thanks a million!

  12. Maggie says:

    I am a patient that is still waiting for a definite diagnosis and to make a long story short it is not a good idea to change locations and end up with a know-it-all specialist!! who has not even bothered with the work done by the previous doctor.

    I came here because I want to research on the the impact of weather upon my body. Since my teens I have experienced the following:

    1, due to the after effects of too many sprained ankles to keep count, when rain is approaching my ankle tends to swell. The pain is similar to the pain experienced when I have sprained it yet again!! As a joke I once predicted to within about 30 minutes when rain was going to arrive and I did this based upon when the pain and swelling began in my ankle, and cheated by looking at the clouds that were gathering.

    2. The ankle swelling was always worst in the summer, and in particular when I was living in a humid climate.

    3. Lower leg pain during cold temperatures. This was noticeable when I lived in a colder climate aka Canberra near the Snowy Mountains here in Australia. The pain was noticeable as soon as the cold was hitting. I noticed similar but not as bad when I lived in Ohio (I was younger then). I do note however, that I did not experience the same thing the first time I lived in Canberra.

    4. The onset of pain in humid conditions was most noticeable when I lived in Townsville. Over the dry period I was fine and could move around quite ok. As soon as the wet season began, with an increase in humidity I could barely move.

    5. It is not just an ankle issue either, because this kind of pattern is also notable near the sacro-iliac joint. When there are changes in barometric pressure I usually feel it near my coccyx. It is such that if there is rain on the way I tend to have a very restless night because of pain located near my right hip.

    My previous specialist had categorized me as MCTD but that changed to early RA about a year prior to moving from Canberra to the Central Coast of NSW. I was placed on Methotrexate and had mixed results. The specialist I attended on the Central Coast, even though he had not seen any test results claimed I did not have RA and that it was Fibromyalgia. He knocked back the dose of Methotrexate. I cannot take sulfasalazine because I had a reaction and my ANA was climbing. Prior to going on the methotrexate my rheumatoid factor indicator was climbing but I was testing negative to the other test. Since having the lower dose of methotrexate I noticed that where the RF indicator had been dropping it is rising again.

    In all I have experienced these things around 40 years.

    So, the question becomes: Does weather also affect Fibromyalgia to the exclusion of RA or is weather a factor in helping to diagnose RA?

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  14. Ruth Loeffler says:

    Hi,
    Thanks for the response and suggestions. My house has a dehumidifier. There is no mold. It is a pretty good house. I do drink kafir. Love it. Just had some five min ago!! I live near one of the great lakes. I am from Costa Rica and the weather is warmer there 6 months of the yr. Then, it rains and is damp yet it is never below 45F and summers (dry season) is not humid.
    I do not eat red meat, seldom eat seafood and almost no poultry. I will look at the sweet intake. I do love 1-2 cups of chai tea and a bit of chocolate and one cup of coffee a day no sugar but a low sweet cookie. But yes, I think I can feel more pain. I heard that sugar causes inflammation. Yet, as I mentioned, I eat pretty healthy: a good amount of organic food, whole grain and do home cooking often.
    I will look into your suggestions. Appreciate so much your comments! I so much sympathize with all of the arthritis sufferers, It takes such a toll to experience a lot of pain and fatigue practically every day, and family members have a hard time believing or accepting our word for it because there are no open wounds!!!! I get the sense that they think sometimes that we are lazy. On top of that there is stereotypes since I am a Latina.
    I suggest all of you to do guided relaxation with very soothing music, gentle breathing practices, affirmations. In yoga there is a practice called Yoga Nidra, yogic sleep in which one is not completely asleep (although many do fall asleep but this can be very good too) . This is a form of self hypnosis and it helps to balance the feel good hormones and diminishes pain. Having a pet also is so soothing. I love cats, they are therapy too.
    So, lets be positive and use faith in our managing these pains!
    Nama
    ste! (is Sanskrit and means “the Divine in Me salute the Divine in You”).

  15. Ruth Loeffler says:

    Hello Eamon,
    I am wondering where you are located? I am in the Northeastern part of the USA.
    Thanks so much for the suggestions. I have been looking into them all.
    Best wishes,

    Ruth

  16. Eamon says:

    Hi Ruth, I am based in sunny Central Coast -Australia. However, It might be sunny but it does get very humid and damp in certain times of the year. With standard building designs!!, the dampness rises with the heat from the soil in sub-floor and into the cavity walls and flooring, this in turn creates a damp cold internal environment.

  17. Ruth says:

    I see, you are really far. I strongly recommend hatha yoga with very soothing music. It is so helpful, it is gentle and helps with stretching, breathing and exercising gently. The meditation aspect is very calming. Helps posture, oxygenating more the tissues and much more.
    A new discovery I just made and tried. It really has helped me!!!Apple cider vinegar compresses. I had some trigger points on the upper back. Always have them, sometimes worse and was reading natural home remedies. So, I tried it (put a compress overnight) and next day wake up with very relaxed and painless upper back!!!!!!!!!! Amazing! I am so thrilled, specially because now I have a strong cold as well as a torn heel ligament as well!!! .
    It is fall and the cold weather certainly brings a lot of pain. I live near a one of the Great Lakes in the USA which affect RA and fibromyalgia.
    So, people. Take care and love yourself!
    Namaste (I honor highest Self in you).

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