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
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.
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.)
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.
Thanks for this post, I also have an arthritis and this will surely help.
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 !
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….
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.