Examining Seasonal Variations in Rheumatoid Arthritis

Rheumatoid arthritis (RA) doesn’t go on vacation but there is evidence to suggest that the condition is less active at certain times of year. We explore a brief timeline – working backward – of evidence collected on the subject.

Notable Studies

A trio of studies completed over the span of more than a decade found that RA symptoms are generally more pronounced in spring and winter and ease up in fall and summer.

• Drawing from a nationwide database in Japan, researchers investigated 12,839 patients with RA whose disease activity was recorded in spring (n=3250), summer (n=916), fall (n=1021), and winter (n=7652). The investigators used the Disease Activity Score (DAS28-CRP), Simplified Disease Activity Index (SDAI), and Clinical Disease Activity Index (CDAI) to measure RA activity. They found that disease activity was highest in spring and lowest in fall. Their findings were published in BMC Musculoskeletal Disorders earlier this year.¹
• In 2016, researchers concluded that general and physical fatigue among patients with RA is significantly greater in winter than in summer. For the study, 65 participants aged 20 to 65 years from a rheumatology clinic in Sweden provided self-assessments of their fatigue at 7 time points during each season. They used a 0 to 100 mm visual analogue scale (VAS) and the Bristol Rheumatoid Arthritis Fatigue Multidimensional Questionnaire (BRAF-MDQ). Their findings were published in BMC Musculoskeletal Disorders.²
• Researchers examined 1665 patients with RA from a large observational cohort. Participants were evaluated on 10 criteria including DAS28, health assessment questionnaire (HAQ), and tender joint count (TJC28). With one exception – the physician’s global assessment of disease activity – RA activity was found to be higher in spring and lower during fall. The findings were published in Rheumatology in 2007.³

Takeaway

It may come as little surprise that RA symptoms tend to intensify in colder months, as some studies suggest that cold weather and joint pain are related. Be sure to remind your patients to take measures to manage their symptoms during the colder months, including^4-6:

• Dressing warmly and wearing loose layers
• Choosing outerwear that’s easy to put on and take off
• Inquiring about pain relievers such as nonsteroidal anti-inflammatory drugs (NSAIDs)
• Taking part in joint-friendly activities such as walking and biking
• Warming up before exercising 
• Finding enjoyable in-home activities so as to avoid going outdoors in frigid temperatures
• Staying hydrated
• Getting a yearly flu shot
• Eating a healthy diet low in fat
• Staying on top of prescribed medication

References

1. Mori H, Sawada T, Nishiyama S, et al. Influence of seasonal changes on disease activity and distribution of affected joints in rheumatoid arthritis. BMC Musculoskelet Disord. 2019;20(1):30. 
2. Feldthusen C, Grimby-Elkman A, Forsblad-d’Elia H, Jacobsson L, Mannerkorpi K. Seasonal variations in fatigue in persons with rheumatoid arthritis: a longitudinal study. BMC Musculoskelet Disord. 2016;17:59.
3. Iikuni N, Nakajima A, Inoue E, et al. What’s in season for rheumatoid arthritis patients? Seasonal fluctuations in disease activity. Rheumatology. 2007;46(5):846-848.
4. How to ease winter rheumatoid arthritis symptoms. Everyday Health. Updated November 14, 2017. Accessed July 18, 2019.
5. Repinski K. Getting through winter with arthritis: 8 tips to ease joint pain and stay safe. CreakyJoints.org. January 4, 2019. Accessed July 18, 2019.
6. Physical activity for arthritis. Centers for Disease Control and Prevention. Reviewed November 8, 2018. Accessed July 18, 2019.