Joint Pain during Winter

Hardly anyone really likes cold, wet, and windy weather – there’s only one word in the world that really describes this condition: usselig – a word from the language spoken in and around my hometown Cologne (the city with the cathedral, the Kölner Dom). But people with inflammatory rheumatic disease and also people with osteoarthritis suffer even more during this season. And actually it isn’t “Hello darkness, my old friend” – quite a lot of people get the blues during the darker months, which also affects pain and not only mood disorders. Besides the joint pain (arthralgia), these people also suffer from pain in the muscles (myalgia).

It isn’t the lower temperature alone; as inflamed and painful joints are very responsive to the application of local, dry cold packs (ice and cold water in a plastic bag are suited best for the purpose). Decisive for the increased pain is the humidity and some people think also the lower air pressure.

E.M. Savage and colleagues addressed the question: “Does rheumatoid arthritis disease activity correlate with weather conditions?” As the authors are based in Belfast, they have enough humid weather. They concluded: “In this study, rheumatoid arthritis disease activity (as measured by DAS-28) was significantly lower in both more sunny and less humid conditions.”

W.R. Patberg and J.J. Rasker looked at: “Weather effects in rheumatoid arthritis: from controversy to consensus. A review.” They came to the conclusion: “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.”

Muscles and joints receive less blood during winter as other organs are favored. And the restrictions on movement per se add to lower joint mobility; the synovial fluid loses its lubricity and then pain intensifies – a vicious circle to be broken. Therefore patients should be encouraged to put on warm clothes (not forgetting gloves, hats and scarves) and walk a lot in fresh air. During daytime and especially, when the sun comes out of hiding as this counteracts the blues. However, Vitamin D isn’t produced in large enough amounts during the winter half year (in latitudes like Germany or higher up).

Links:

https://www.prisma.de/magazin/gesundheit/Rheuma-und-Gelenkschmerzen-im-Winter-was-tun,21316928

E.M. Savage and colleagues: https://www.ncbi.nlm.nih.gov/pubmed/25342437

W.R. Patberg and J.J. Rasker: https://www.ncbi.nlm.nih.gov/pubmed/15229951

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Weather Changes 2

Let’s better call it: the next day. Or: always sunshine after rain. I tried to shoot two pictures just of the same area like yesterday in the late afternoon. It’s 07:10 a.m.

F/4.2, 1/239 s, ISO-100, 16 mm, 

screenshot, else unprocessed

F/3.8, 1/1263 s, ISO-100, 10 mm, 

screenshot, else unprocessed

Link:

http://rheumatologe.blogspot.com/2018/05/weather-changes.html

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Weather Changes

This noon I had been sitting in heavy sunshine during my lunch break. But now (5:20 p.m.), when usually I try to get a second short break in the sun, the weather has changed completely within three or four hours.

F/3.3, 1/40 s, ISO-200, 10 mm, screenshot, 

else unprocessed

F/3, 1/30 s, ISO-160, 5 mm, screenshot, 

else unprocessed

with part of our hospital

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Rheumatoid Arthritis and the Comfort Zone

Most patients complain about weather associated aggravation or even flares of their rheumatoid arthritis. There are one few studies addressing the issue, of which I’ve selected some recent ones.

E.M. Savage and colleagues published a study [1]: “Does rheumatoid arthritis disease activity correlate with weather conditions?” They concluded: “In this study, rheumatoid arthritis disease activity (as measured by DAS-28) was significantly lower in both more sunny and less humid conditions.”

L. Abasolo an colleagues presented [2]: “Weather conditions may worsen symptoms in rheumatoid arthritis patients: the possible effect of temperature.” In results the authors tell us: “245 RA patients who visited the emergency room 306 times due to RA related complaints as the main diagnostic reason were included in the study. Patients from 50 to 65 years old were 16% more likely to present a flare with lower mean temperatures.”

G. Smedslund and K.B. Hagen presented a meta-analysis [3]: “Does rain really cause pain? A systematic review of the associations between weather factors and severity of pain in people with rheumatoid arthritis.” This is their conclusion: “The studies to date do not show any consistent group effect of weather conditions on pain in people with RA. There is, however, evidence suggesting that pain in some individuals is more affected by the weather than in others, and that patients react in different ways to the weather. Thus, the hypothesis that weather changes might significantly influence pain reporting in clinical care and research in some patients with RA cannot be rejected.”

G. Smedslund and another group of colleagues presented [4]: “Does the weather really matter? A cohort study of influences of weather and solar conditions on daily variations of joint pain in patients with rheumatoid arthritis.” The authors concluded: “Weather sensitivity seems to be a continuum and a highly individual phenomenon in patients with RA. In the present sample, pain was significantly associated with 3 or more weather variables in 1 out of 6 patients, for whom the magnitude of weather sensitivity might significantly influence pain reporting in clinical care and research.”

About four years ago I collected statements of patients concerning weather sensitivity [5]. Most complaints are centered on wet and cold weather, weather change, high or low temperature, which all lead to discomfort.

I would like to see a study in which the comfort zones of patients with inflammatory diseases like rheumatoid arthritis are compared to normal individuals. Parameters could be air temperature, air pressure, humidity, air speed. What are the effects of a breeze at high or low temperatures?

To sum it up, weather conditions influence comfort or discomfort in patients with inflammatory diseases like rheumatoid arthritis, but we still don’t know how to enlarge the comfort zone for our patients.

Links:

[1] https://www.ncbi.nlm.nih.gov/pubmed/25342437

[2] https://www.ncbi.nlm.nih.gov/pubmed/23829960

[3] https://www.ncbi.nlm.nih.gov/pubmed/20570193

[4] https://www.ncbi.nlm.nih.gov/pubmed/19714599

[5] http://rheumatologe.blogspot.de/2013/11/weather-and-inflammatory-rheumatic.html

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Fibromyalgia at the ACR 2015 Meeting in San Francisco / Miscellanea

As I cannot discuss all studies presented at the ACR 2015 Annual Meeting in San Francisco, I have selected a few more without a context – miscellanea.

Robert S. Katz and colleagues presented an observational study: “Patients Who Take Many Medications for Their Fibromyalgia Symptoms at the Initial Office Visit Tend to Have a Worse Clinical Course”. Conclusion: “Those patients taking more prescription for their fibromyalgia symptoms at their initial office visit tended to have a worse clinical course, evidenced by higher HAQ scores, poor general health, and more pain and fatigue.” I guess all rheumatologists treating fibromyalgia can agree to these findings. Now, we’d like to know, what’s behind this observation. My guess is: a different way of coping, patients in this group might be classified as being passive, avoiding, externalizing, alexithymic.

Thomas Romano presented a study (?): “Correlation of Magnesium Levels and IGF-! Levels in Fibromyalgia Patients”. Background/Purpose: “To determine if there is a correlation between RBC Mg levels and IGF-! levels in Fibromyalgia (FM) patients”. “All [patients] fulfilled ACR 1990 Criteria for FM.” Conclusion: “There was a statistically significant positive correlation between IGF-1 levels and RBC Mg levels in the 60 FM patients studied. This has implications for treatment and further diagnostic testing.” Maybe there is a correlation, so what? And maybe it’s time to use the new ACR criteria. For sure it’s a bold statement that this correlation of (unnecessary?) lab tests of selected patients should have implications for treatment and further diagnostic testing.

Low IGF-1 levels in fibromyalgia patients have already been shown in 1992; please refer to the study by RM Bennett and colleagues; somatomedin C has been renamed IGF-1. So, again I must say: nothing new under the sun.

Daniel Kim and colleagues addressed weather in their study: “Evaluating Weather’s Effect on Fibromyalgia Patients Using the Revised Fibromyalgia Impact Questionnaire and the Brief Pain Inventory”. They used a broad set of parameters, but the authors “did not find any statistically significant effect of weather on fibromyalgia symptoms”. It’s like a pendulum. We know from our patients that weather changes and rainy, humid, cold weather conditions are attributed with increased pain and other symptoms of fibromyalgia (as well as inflammatory rheumatic diseases!), but as strange as it may seem, stressable scientific proof is yet to come. I hope that research on this topic will go on.

Lin Ge and colleagues looked at: “Association of Smoking and Cognitive Function in Patients with Fibromyalgia”. Conclusion: “The results of this study indicate that smokers with FM report worse cognitive function. Although the cause-effect relationship between smoking and cognition is unclear, clinicians who care for patients with FM should be aware of this association.” I think, I’ll take this study and others to look more closely at the diseases we treat and the effects of smoking. Some studies are congruent with these findings, others are not. I guess we all agree that smoking isn’t healthy and may worsen symptoms and make treatment less effective. Concerning cognitive function there seems to be a link to Alzheimer’s and dementia per se.

References:

Katz RS, Katz Small A, Leavitt H. Patients Who Take Many Medications for Their Fibromyalgia Symptoms at the Initial Office Visit Tend to Have a Worse Clinical Course [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). http://acrabstracts.org/abstract/patients-who-take-many-medications-for-their-fibromyalgia-symptoms-at-the-initial-office-visit-tend-to-have-a-worse-clinical-course/. Accessed November 12, 2015.

Romano T. Correlation of Magnesium Levels and IGF-! Levels in Fibromyalgia Patients [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). http://acrabstracts.org/abstract/correlation-of-magnesium-levels-and-igf-levels-in-fibromyalgia-patients/. Accessed November 12, 2015.

Bennett RM, Clark SR, Campbell SM, Burckhardt CS: Low levels of somatomedin C in patients with the fibromyalgia syndrome. A possible link between sleep and muscle pain. Arthritis Rheum. 1992 Oct;35(10):1113-6. PMID: 1418002. http://www.ncbi.nlm.nih.gov/pubmed/1418002.

Kim D, Chan R, Plans M, Hackshaw K. Evaluating Weather’s Effect on Fibromyalgia Patients Using the Revised Fibromyalgia Impact Questionnaire and the Brief Pain Inventory [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). http://acrabstracts.org/abstract/evaluating-weathers-effect-on-fibromyalgia-patients-using-the-revised-fibromyalgia-impact-questionnaire-and-the-brief-pain-inventory/. Accessed November 12, 2015.

Ge L, Oh TH, Vincent A, Mohabbat A, Jiang L, Whipple M, McAllister S, Wang Z, Qu W. Association of Smoking and Cognitive Function in Patients with Fibromyalgia [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). http://acrabstracts.org/abstract/association-of-smoking-and-cognitive-function-in-patients-with-fibromyalgia/. Accessed November 12, 2015.

Fibromyalgia and smoking: http://rheumatologe.blogspot.de/2011/11/fibromyalgia-and-smoking.html