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Seasonal Variation in Rheumatoid Arthritis

Original Editor - Jenis Bhalavat Top Contributors - Jenis Bhalavat, Reem Ramadan, Mariam Hashem, Kim Jackson, Lucinda hampton, Leana Louw and Lauren Lopez

Introduction

Rheumatoid arthritis (RA) is a chronic, immuno-inflammatory disease that involves the immune system attacking its own tissues. It mainly affects the lining of the hand, wrist, and knee joints. This causes pain, swelling, stiffness, deformity and unsteadiness at the level of the joint[1]. The cause of rheumatoid arthritis is unknown however, it is thought to be triggered by smoking, genes, and infections[2]. Although cold weather does not cause arthritis, RA patients tend to complain of an exacerbation of pain and ache during the winter season[3].

Influence of Seasonal Parameters on Joints

The seasonal parameters - atmospheric pressure, temperature and humidity have known to cause a flare-up in RA or trigger the disease.

Atmospheric Pressure

Atmospheric pressure, the force exerted by the atmosphere at a given point, is measured by a barometer and varies with altitude and seasons. For physiotherapists treating rheumatoid arthritis (RA) patients, understanding the relationship between atmospheric pressure and pain is important.

Several theories attempt to explain this relationship:

  • Cartilage wear in arthritis exposes nerves, making them more sensitive to pressure changes.
  • Decreased atmospheric pressure in winter causes muscles and tendons to expand and contract, putting more pressure on nerves and causing pain.
  • Cold weather thickens joint fluid due to changes in hydrostatic pressure from barometric pressure shifts, leading to increased joint stiffness, pain, and reduced range of motion.

A clinical trial with 200 participants found that arthritis pain severity is modestly associated with weather conditions, with colder temperatures linked to greater pain. This information can help physiotherapists better understand and manage seasonal variations in RA symptoms.[4]. [5].[6][7] [8].

Humidity

High humidity levels cause sweating and dehydration which lead to blood thickening due to the loss of blood volume which is the blood circulating through body. This leads to an increase in blood pressure forcing the body to put in more work in order to pump blood which eventually lead to a decrease in the concentration of fluid around the joint causing increased friction between the joints, inflammation and joint pain[9]. According to a study that included 1811 RA patients, every 10 mg/L increase in C-reactive protein, a protein made by the liver that indicates the presence of an inflammation, was associated with a 0.38 mmHg reduction in systolic blood pressure[10]. In addition to that, according to another study conducted on patients with different pain conditions predominantly arthritis, the occurrence of a painful event was 12% higher with an increase in humidity compared to a decrease in atmospheric pressure (4%) and higher wind speed (4%)[11]. The classic opinion, "Cold and wet is bad, warm and dry is good for RA patients," seems to be true only as far as humidity is concerned.[12]

Temperature

When the temperature drops, our body tends to try and conserve heat by the constriction of blood vessels leading to joint pain and stiffness. This occurs due to the effect temperature has on our muscles and soft tissues causing them to become stiffer to aid in vasoconstriction[13]. Low temperatures may also increase the thickness of joint fluids, making them stiffer and more sensitive to pain during movement. According to a study, patients with RA whose age ranges between 50 to 65 years old were most likely to report a flare with a drop in temperature[14]. Also, a change in season causes a rise in level of IgG antibodies (Rheumatoid factor), thereby triggering the RA inflammatory mechanism in the body[15]. Based on another study, results showed that there was a significant association between low temperature and admission for RA where the tendency to go to the hospital differed between age groups, those below the age of 65 and those above the age of 65, and the risk of admission for RA during cold weather was higher for females compared to males[16]. Also, according to the Arthritis Foundation who published a study from Tufts University in 2007 found that every 10-degree drop in temperature corresponded with an incremental increase in arthritis pain.[17]

Genetic and Epigenetic Mechanism

Rheumatoid arthritis (RA) is an autoimmune disease causing joint inflammation and damage. Both genes and environment contribute to RA development.

RA symptoms often worsen in winter. Researchers studied how seasons affect RA-related genes and epigenetic factors (which influence gene expression).

They found that many RA-linked genes and epigenetic processes are influenced by seasonal changes. These seasonal effects may disrupt the body's self-recognition, leading to autoimmune reactions.

This research helps explain why RA flares tend to occur seasonally. Climate variations appear to drive changes in genetic and epigenetic processes, potentially triggering the production of autoantibodies that cause RA flares.[18].

Role of Physiotherapy

The main goals of physical therapy when it comes to rheumatoid arthritis involve pain relief, preventing joint damage and functional loss, and reducing functional impairment in daily living activities. As physiotherapist have a long term follow up with RA patients, they can document the seasonal parameters using various weather apps during which the patient experiences pain. Depending on these records, the therapist can predict when will there be a next trigger of RA pain and pre-plan the treatment[11]. One therapeutic modality that can be used is electrostimulation specifically TENS, transcutaneous electrical nerve stimulation, which would aid in relieving pain with analgesia persisting for 18 hours when high frequencies are applied[19]. Similarly, the application of Interferential Current Therapy also aided in relieving pain, swelling and improving range of motion[20]. Another modality would be massage which aids in diminishing swelling at the joint and releasing muscle surrounding the painful joints where studies have showed that the use of manual massage have decreased pain threshold in RA patients[21]. Also, wearing compression gloves aids not only in keeping the patient warm but also aids in pain relief by reducing joint swelling[22]. In addition to that, exercise therapy is very beneficial because muscle weakness can occur due to RA however prior to implementation of the exercise program several characteristics should be taken into consideration including whether the involvement of the joints is local or systemic, stage of the disease, age of the patient, and compliance of the patient with the therapy. The patient can be recommended various exercises before the onset of RA reducing the pain and stiffness. For example the patient might experience pain whenever the pressure is 1002 mbar, humidity at 17% and temperature 41 degrees, so we can alert the patient whenever these conditions are reached to take preventative measures. In the case of acutely inflamed joints, isometric exercises are done and should not be done beyond 40% of maximum voluntary contraction because they may lead to impairment in blood circulation and fatigue after the exercise and patients with active arthritis should particularly avoid activities such as climbing stairs or weight lifting and excessive stress over the tendons during the stretching exercises should also be avoided[23]. In chronic conditions with inactive arthritis, conditioning exercises such as swimming, walking, and cycling with adequate resting periods are recommended for they increase muscle endurance and aerobic capacity and improve functional capabilities of the patient. Furthermore, the use of pneumatic pressure pumps have been found useful in reducing pain and swelling during seasonal flare up[24]. Alternatively the patient can be asked to change the location whenever the weather conditions turn unfavorable.

References

  1. ↑ Rheumatoid arthritis. National Institute of Arthritis and Musculoskeletal and Skin Diseases. U.S. Department of Health and Human Services. Available from: https://www.niams.nih.gov/health-topics/rheumatoid-arthritis (accessed 5/1/2023)
  2. ↑ Rheumatoid arthritis (RA): Causes, symptoms & treatment. Cleveland Clinic. Available from: https://my.clevelandclinic.org/health/diseases/4924-rheumatoid-arthritis (accessed 5/1/2023)
  3. ↑ Paturel A. Why is Arthritis Worse in the Winter? [Internet]. Cedars Sinai. 2022 [cited 5 January 2023]. Available from: https://www.cedars-sinai.org/blog/arthritis-worse-in-winter-winter.html
  4. ↑ Hilary Costa, Erin Sprout. Atmospheric pressure. Jeannie Evers, editor. National Geographic Society. Available from:https://education.nationalgeographic.org/resource/atmospheric-pressure (accessed 6/1/2023)
  5. ↑ Oliva L. How does cold weather affect arthritis? Cano Health. Available from: https://canohealth.com/news/blog/how-does-cold-weather-affect-arthritis/ (accessed 6/1/2023)
  6. ↑ How cold weather affects arthritis? OrthoVirginia. Available from: https://www.orthovirginia.com/blog/how-cold-weather-affects-arthritis/ (accessed 6/1/2023)
  7. ↑ Mitchell A. Arthritis and winter: Whether the weather causes pain in arthritic joints! Elizabeth Street Physiotherapy. Available from: https://elizabethphysio.com.au/arthritis-and-winter-whether-the-weather-causes-pain-in-arthritic-joints/ (accessed 6/1/2023)
  8. ↑ McAlindon T, Formica M, Schmid CH, Fletcher J. Changes in barometric pressure and ambient temperature influence osteoarthritis pain. The American journal of medicine. 2007 May 1;120(5):429-34.
  9. ↑ Orthopedic Associates. Dehydration and joint pain. Orthopedic Surgery and Sports Medicine. Available from: https://orthopedicassociates.org/dehydration-and-joint-pain/ (accessed 7/1/2023)
  10. ↑ Yu Z, Kim SC, Vanni K, Huang J, Desai R, Murphy SN, Solomon DH, Liao KP. Association between inflammation and systolic blood pressure in RA compared to patients without RA. Arthritis research & therapy. 2018 Dec;20(1):1-8.
  11. ↑ 11.0 11.1 Dixon WG, Beukenhorst AL, Yimer BB, Cook L, Gasparrini A, El-Hay T, Hellman B, James B, Vicedo-Cabrera AM, Maclure M, Silva R. How the weather affects the pain of citizen scientists using a smartphone app. NPJ digital medicine. 2019 Oct 24;2(1):1-9.
  12. ↑ Patberg WR, Rasker JJ. Weather effects in rheumatoid arthritis: from controversy to consensus. A review. The Journal of rheumatology 2004;31(7):1327-34.
  13. ↑ Ueno S, Yokoyama K, Nakagawa M, Araki S. Effects of pH and temperature on force and stiffness of skeletal muscle fibers during contraction and relaxation in relation to musculoskeletal disorders. Industrial health. 2002;40(4):362-9.
  14. ↑ Abasolo L, Tobías A, Leon L, Carmona L, Fernandez-Rueda JL, Rodriguez AB, Fernandez-Gutierrez B, Jover JA. Weather conditions may worsen symptoms in rheumatoid arthritis patients: the possible effect of temperature. Reumatología Clínica (English Edition) 2013;9(4):226-8.
  15. ↑ Terao C, Ohmura K, Yamamoto K, Yukawa N, Kawabata D, Nojima T, Fujii T, Mimori T. Serum IgG levels demonstrate seasonal change in connective tissue diseases: a large-scale, 4-year analysis in Japanese. Modern rheumatology 2012;22:426-30.
  16. ↑ Huang LJ, Zha JJ, Cao NW, Zhou HY, Chu XJ, Wang H, Li XB, Li BZ. Temperature might increase the hospital admission risk for rheumatoid arthritis patients in Anqing, China: a time-series study. International journal of biometeorology. 2022 Jan;66(1):201-11.
  17. ↑ Arthritis Foundation. Weather and Arthritis Pain. Living with Arthritis Blog. Available from: http://blog.arthritis.org/living-with-arthritis/weather-arthritis-pain/ (accessed 7/1/2023).
  18. ↑ EK KP, PR S, Banerjee M. Impact of seasonal cycle on Rheumatoid Arthritis based on genetic and epigenetic mechanism. Frontiers in Immunology.;16:1601767.Available:https://www.frontiersin.org/journals/immunology/articles/10.3389/fimmu.2025.1601767/abstract (accessed 23.8.2025)
  19. ↑ Mannheimer C, Lund S, Carlsson CA. The effect of transcutaneous electrical nerve stimulation (TNS) on joint pain in patients with rheumatoid arthritis. Scandinavian journal of rheumatology. 1978 Jan 1;7(1):13-6.
  20. ↑ Jarit GJ, Mohr KJ, Waller R, Glousman RE. The effects of home interferential therapy on post-operative pain, edema, and range of motion of the knee. Clinical Journal of Sport Medicine. 2003 Jan 1;13(1):16-20.
  21. ↑ Dhondt, T Willaeys, L. A Verbruggen, RA B Oostendorp, W Duquet W. Pain threshold in patients with rheumatoid arthritis and effect of manual oscillations. Scandinavian journal of rheumatology. 1999 Jan 1;28(2):88-93.
  22. ↑ Culic DD, Battaglia MC, Wichman C, Schmid FR. Efficacy of compression gloves in rheumatoid arthritis. American Journal of Physical Medicine & Rehabilitation. 1979 Dec 1;58(6):278-84.
  23. ↑ Lyngberg KK, Ramsing BU, Nawrocki A, Harreby M, Danneskiold‐Samsøe B. Safe and effective isokinetic knee extension training in rheumatoid arthritis. Arthritis & Rheumatism: Official Journal of the American College of Rheumatology. 1994 May;37(5):623-8.
  24. ↑ Variação Sazonal Na Artrite Reumatóide ir para: Navegação, Pesquisa: Campcursos - Aprimoramento. CampCursos.Available from: https://campcursos.com.br/variacao-sazonal-na-artrite-reumatoideir-para-navegacao-pesquisa/ (accessed 7/1/2023)
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