Welcome to the first installment of Myths and Realities! With each post we hope to tackle some of the longstanding myths often perpetuated by patients and physicians alike. Through literature reviews we will attempt to validate or debunk these beliefs in an evidence-based manner. We hope you enjoy (and learn a little bit)!
Commentary by Aditya Mattoo MD PGY-3
Faculty Peer Reviewed
For our first post, I wanted to address the age old belief that changes in the weather can affect arthritis pain. Since the time of Hippocrates, who wrote about the effects of hot and cold winds on people’s health, this topic has been debated. Even Osler suggested in 1892 that arthritis sufferers of wealth vacation in the south to avoid the cold damp weather of the northern winters.(1) The majority of physicians have had at least one patient claim that his or her arthritis is acting up on account of the changing weather conditions. In fact, surveys have demonstrated that upwards of 90% of patients believe that weather plays a role in their arthritic pain. Some arthritis sufferers assert that they can predict the weather as storm systems are often heralded by joint pain flares. This belief has become so commonplace that even weather reporting services have developed arthritis indices to accompany the daily forecast.
Some of the theories to support the association between weather and arthritis relate pressure and temperature to direct effects on joint biomechanics. Increased atmospheric pressure can increase intraarticular pressure leading to pain as evidenced by joint pains secondary to compression in deep-sea divers.(2) Similarly, lower temperature can effect the compliance of articular structures and synovial fluid viscosity, making joints stiffer. Another proposed mechanism is the fact that temperature and pressure is known to sensitize nociceptors in the densely innervated periarticular structures. (3)
Enough background… let’s get down to business. So what does the data show? Well, the older literature was largely equivocal, limited by flawed study designs trying to measure a subjective complaint. Small sample sizes and single center studies didn’t help either. In more recent years, I am sad to report that the jury is still out. In 2003, Wilder et al prospectively followed 154 patients in the same geographical area with osteoarthritis (OA) who self-reported pain at five body sites.(4) The researchers used temperature, barometric pressure and precipitation data from the US National Oceanographic and Atmospheric Administration (USOAA) to attempt to find a relationship between these weather related variables and the severity of pain complaints. The only statistically significant finding was in a subgroup of women in which worsening pain complaints were seen on days with rising barometric pressure. All other subgroups failed to demonstrate statistically significant associations. Although this was one of the largest studies of the time, it was criticized by its limited geographical scope.
Fueled by the limitations of earlier studies including the one mentioned above, McAlindon et al published a multi-site study which followed 200 patients with knee OA over different times of the year.(5) Using a well validated pain questionnaire (WOMAC) and data from the USOAA the study prospectively compared knee pain with different atmospheric conditions throughout the continental US. Positive correlations were found in this study. The weather associations with statistical significance were ambient temperature and change in barometric pressure. Both lower ambient temperatures and rising barometric pressure were independently associated with increased pain complaints.
As we have learned, whether weather is a contributing factor in arthritic pain can not be stated definitively. Even though the literature is filled with contradicting studies, one of the largest, multi-site studies conducted to date has recently demonstrated an association between the two. To quote Robert Ripley, “believe it or not.”
1 Osler W. The Principles and Practice of Medicine: Designed for the Use of Practitioners and Students of Medicine (1892). Birmingham: Classics of Medicine Library, 1978.
2 Compression Pains. In: US Navy Diving Manual. Revision 4 ed. Naval Sea Systems Command, 3-45, 1999.
3 Verges J et al. Weather Conditions can Influence Rheumatic Diseases. Proceedings of the Western Pharmacology Society, 47:134-136, 2004.
4 Wilder FV et al. Osteoarthritis Pain and Weather. Rheumatology, 43:955-958, 2003.
5 McAlindon T et al. Changes in Barometric Pressure and Ambient Temperature Influence Osteoarthritic Pain. American Journal of Meidcine,120:429-434, 2007.
Faculty Peer Reviewed By: Svetlana Krasnokutsky, MD Division of Rheumatology