Medical Author: William C. Shiel Jr., MD, FACP, FACR
Medical Editor: Catherine B. Driver, MD
Doctors who specialize in the treatment of patients with arthritis (myself included) generally agree that many patients experience a worsening of joint symptoms with changes in the weather. Moreover, folklore holds that the weather can affect arthritis as emphasized by sayings like "feeling under the weather." We know, for example, that weather clearly influences many health conditions. Examples of this relationship include pollens in the air and asthma or sinus infection, sun rays and skin burning or skin cancer, cold weather and heart attacks, and gloomy, dark weather and depression. We also know that heat packs or hot showers can relax the muscles around the joints and relieve stiffness and pain for some. Conversely, ice packs can ease the inflammation in the joints themselves.
But does the weather actually affect arthritis? If so, how?
First, there hasn't been much real research science addressing this question. In 1961, famous arthritis specialist J. Hollander, MD, 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. Neither weather factor by itself seemed to influence joint symptoms. The study has been criticized because of the limited number of patients evaluated (12 patients). The theory of the study is that inflamed joints swell as the barometric pressure drops. This swelling irritates the nerves around the joints that sense pain and causes more stiffness.
Well, if this theory proved correct (and it is not universally accepted), should a person with arthritis move to a region with a dry climate?
The answer is no. Relocating to a different climatic environment does not seem to make a difference in the long run. Scientific studies have shown that no matter where people live their bodies seem to establish a new equilibrium to the local climate. As a result, changes in the weather affect the arthritis symptoms in the same manner regardless of the actual overall average weather. Moving is not likely to be beneficial long term. (To emphasize a point, I can tell you that there are plenty of busy rheumatologists in Arizona!)
What is the bottom line?
It appears that there is some evidence that the symptoms of certain people with arthritis are influenced by changes in the weather. This is not true for all people with arthritis, nor is it predictable what type of weather alterations will bother people. For example, in one room I may have a patient complaining that last week, just before it rained, her joints began aching and now that the weather is warm and clear she feels better. Simultaneously, in the next room, a patient tells me that her joints are far worse today after it rained last week! What do I do with this information? Well, each patient must be evaluated (and evaluate themselves) uniquely. The bottom line is that while the exact cause(s) of the activation of arthritis symptoms may not yet be scientifically understood, each patient must make lifestyle and/or medication adjustments according to the particular weather conditions that they note influence their symptoms.
If a patient does experience joint pain and stiffness with weather changes, how harmful is this?
It is very important to appreciate that only joint symptoms (such as pain and stiffness) are influenced by weather. We do not have any evidence that weather changes lead to joint damage. Furthermore, weather changes have not been related to whether or not an individual develops arthritis.
Special rheumatic conditions
There are special rheumatic conditions that may be associated with arthritis and are clearly influenced by weather. In fact, as a rheumatologist, it is my job to inform patients with these conditions that they should do their best to avoid aggravating these conditions by limiting their exposure to certain weather situations. Here are some of these special conditions.
The risk of muscle cramping increases when an exercise activity is pursued without an adequate warm-up. This is particularly true in environments that are cold. Therefore, it is very important to do warm-up stretches and get the muscles ready to work for you before you get in the game!
Systemic lupus erythematosus (lupus)
Lupus is a potentially serious illness that can cause inflammation in a variety of internal organs, including the joints. Lupus can have a tendency to be activated by exposure to sunlight, a feature referred to as photosensitivity. Since ultraviolet light can trigger and worsen flare-ups of lupus that can involve the skin and/or the joints and other organs, patients with lupus should avoid sun exposure. Sunscreens and clothing that cover the extremities are essential.
Raynaud's phenomenon can be associated with a number of conditions that feature arthritis, including scleroderma, rheumatoid arthritis, systemic lupus erythematosus, mixed connective tissue disease, polymyositis, and others. Raynaud's phenomenon is a condition that results in the discoloration of the fingers and/or the toes when the patient is exposed to changes in temperature (cold or hot) or emotional events. Skin discoloration occurs because an abnormal spasm of the blood vessels results in a diminished blood supply. Initially, the digit(s) involved turn white because of diminished blood supply. The digit(s) then turn blue because of prolonged lack of oxygen. Finally, the blood vessels reopen, causing a local "flushing" phenomenon, which turns the digit(s) red. This three-phase color sequence (white to blue to red), which occurs most often upon exposure to cold temperature, is characteristic of Raynaud's phenomenon. People with Raynaud's phenomenon should minimize their exposure to extremes of temperature (particularly cold) and rapid changes of temperature. These patients can often benefit by living in environments that are warmer. This may mean moving for patients with severe disease. To emphasize (and offer a potential financial pearl), it should be noted that the utility companies in many states offer discounts for people with weather-related conditions that require extra heating!
QUESTION
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