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 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.

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