Weather changes fail to impact risks for osteoarthritis pain, rheumatoid arthritis

Julia Buchfuhrer, DO

Every winter, joint pain specialists are flooded with patients complaining of increased osteoarthritic pain due to the cold. This article seems to challenge that idea while also admitting that patients do complain of cold-related joint pain. So, which is it?

The analysis included too many diagnoses. We all know gout, rheumatoid arthritis and osteoarthritis are quite different diseases on a pathophysiologic level. Lumping all of these diagnoses together as “musculoskeletal pain” is inherently flawed. Fibromyalgia and chronic pelvic pain were even included as diagnoses, and they are not even arthritis conditions.

The authors also mentioned that hospital data were used. If you’ve ever stepped foot into a hospital, you know they have a climate that is entirely all their own. We cannot appropriately correlate outside data about temperature with hospital data about joint pain.

Furthermore, 10 Celsius (50 Fahrenheit) was used as the minimum temperature cutoff. That temperature could be considered very warm or fairly cold depending on where you live. Thus, an absolute cutoff isn’t an appropriate measure of “cold” worldwide.

In the end, if my patients come to me in the winter complaining of increased joint pain, who am I to tell them that what they are experiencing isn’t real?

John R.P Tesser, MD

Can you remember the last time a patient reported that their osteoarthritis, rheumatoid arthritis or low back pain flared with the last change in weather? Was it yesterday, or maybe the day before? Well, Ferreira and colleagues’ recent meta-analysis would divest your understanding that there is any correlation between weather changes and flares of back, osteoarthritis, rheumatoid arthritis, knee, hip, pelvic pain, headaches, or any musculoskeletal pain for that matter.

In 1963, Joseph Hollander, MD, one of the founding forefathers of modern rheumatology, and Sarantos Yeostros, MD, experimented on eight RA and four OA patients who had reported such worsening of symptoms with weather changes — clearly channeling bias selection — in the Climatron. This was a closed, controlled climate chamber constructed at the University of Pennsylvania to house two patients for 2 to 4 weeks of observation while continuously controlling temperature, humidity, air flow, barometric pressure, and air ionization without the knowledge of the patients.

They concluded that it appeared that the changing of conditions, rather than the humidity or barometric pressure alone, exerted a detrimental effect on arthritic symptoms. In addition, they stated it seemed “reasonable to conclude that weather effect on arthritis is a definite phenomenon, and not just another old wives’ tale.”

The more current meta-analysis was conducted in the usual fashion of a systematic literature search. The methodology is the case-crossover design considered the gold-standard approach to quantify the risk of an event associated with transient exposures.

Pooled analyses showed no association between relative humidity, air pressure, temperature, or precipitation and the risk for RA, knee pain or low back pain. On the other hand, high temperatures combined with low humidity were associated with increased pain, redness, and joint swelling in people with gout.

How to address this apparent discrepancy? To be fair, some of the forest plots did show trends of affects, but they did not meet statistical significance. This clearly indicates that, at least for some patients, these effects did occur. It’s the challenge that we all have in applying results from highly sophisticated, statistically pooled analyses to real patients individually. Somehow, I don’t think this is the last we’ll hear about the subject — including from the next patient who reports to you that their RA flared with the recent change in the temperature and humidity.