Many patients with rheumatic diseases especially those presenting with arthritis report increasing pain and stiffness during cold seasons.
Tales abound of how some patients can actually ‘predict’ the onset of rain or cold weather from these symptoms. Whether it is a knee acting up when a rainstorm is on the horizon or, worse yet, a full-fledged rheumatoid arthritis flare when a blizzard hits, many of those with rheumatic diseases swear the weather harms their conditions.
The precise mechanism for this observation is not clearly understood, but it is thought that changes in weather can cause expansion and contraction of tendons, muscles, bones, and scar tissues, resulting in pain in the tissues that are affected by arthritis.
Low temperatures may also increase the thickness of joint fluids, making them stiffer and perhaps more sensitive to pain during movement.
What causes autoimmune diseases?
Before addressing what precautions people living with rheumatic diseases can take during the rainy season, it is important to first understand what causes the condition. Anything foreign or toxic to our body are collectively called anti- gens; mostly some form of proteins or carbohydrate.
The immune system identifies these antigens and produces antibodies to get rid of them. Our cells, which are also made up of proteins and carbohydrates, escape the action of these soldiers due to the presence of specific distinguishing features called “self-antigens.” The immune cells, during their development in the thymus and bone marrow, are exposed to these self-antigens and made tolerant to them.
In a healthy individual, these tolerant cells go on to mature and become cells of the immune system. The body destroys the intolerant ones.
Many times, due to discrepancies in this process of destruction, the autoreactive immune cells escape the surveillance and can cause autoimmune disorders. These discrepancies can be genetic in origin, there could be a mutation in the self-antigens, or excessive and uncontrolled inflammation can lead to an overactive immune system.
Systemic autoimmune disorders occur when the effect of the autoreactive cells are seen all over the body, in conditions like lupus, rheumatoid arthritis, multiple sclerosis, and ankylosing spondylitis.
How does it manifest?
Arthritis is a common manifestation of most rheumatic diseases and is usually a result of inflammation.
Typical presentation includes:
- Joint pains
- Joint stiffness, especially in the morning and after prolonged rest
- Joint swelling
- Warmth and redness
- Difficulty using the joint normally
What precautions can people living with rheumatic diseases take during the cold season?
Patients with rheumatic diseases should be on effective treatment that ensures adequate disease control and suppression of inflammation at all times.
Treatments cannot cure autoimmune diseases, but they can control the overactive immune response and bring down inflammation or at least reduce pain and inflammation. These treatments include; non-steroidal anti-inflammatory drugs (NSAIDS), steroids, immunosuppressive drugs, and newer agents called biologic drugs.
Keeping warm: Dressing warmly, avoiding contact with cold water, take a warm shower, use hand gloves, warm bedding, and eat warm foods and beverages to reduce some of the effects seen when there is a drop in ambient temperature.
Exercise regularly: Exercise is crucial for patients living with arthritis. It is known to ease pain, increase strength and flexibility, and boost energy. The tendency during cold weather is for many people to shy off exercises. Patients should however prioritise exercise as this can ease the pain experience.
Dr Otieno is the assistant professor and consultant physician and rheumatologist at Aga Khan University Hospital, Nairobi.