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INTRODUCTION: 

Rheumatoid Arthritis (RA) is an autoimmune disorder, this is a condition where the body’s natural defence system mistakes its own healthy tissue as foreign and attacks them. RA is also multifactorial meaning that as well as affecting the joints can affect other parts of the body such as our kidneys, heart, eyes, as well as the nervous and digestive system. This can cause uncomfortable pain in the people with it, and leads to synovitis, a disorder where the synovial membrane is inflamed in our body.  

This membrane acts as an important protective layer which covers our joints. Genetics can play a role in the development of the disease as well as other risk factors however the end result of the factors is an overproduction of proinflammatory cytokines which includes tumour necrosis factor (TNF) and interleukin-6 (IL-6) which both cause a rapid increase in synovial cells within the joints, and leads to pannus formation (swelling of the lymph gland), and degradation of cartilage and bone (1).  

The etiology of RA is currently not known, and the pathophysiological mechanism of the disorder is also unclear making it difficult to manage, meaning RA requires an approach that utilizes a broad range of disciplines. RA also displays itself as a chronic disease which effects the same joints on both sides of the body, at first it affects small joints such as the proximal interphalangeal and metacarpophalangeal joints (joints located in the knuckle region of hands), and then develops to larger joints. People tend to experience this as a painful and stiff sensation, which causes a lowered quality of life. During the winter months, cold weather can exacerbate this pain. 

 
DIAGNOSIS: 

 
RA patients usually describe a recent swelling of the joints, as well as tenderness. Morning joint stiffness is also described as a symptom of RA. Precise diagnosis of RA in good time is vital in the treatment of the disorder, due to an early diagnosis being able to stop the disease in most patients. Usually, a physical examination will occur to check your joints for swelling, and test the ease of movement, this is then combined with an assessment of risk factors, family history, and ultrasound sonography and laboratory assessment of C-reactive protein (CRP) and Erythrocyte sedimentation rate (ESR) in the serum to see if RA- specific structures can be detected and measure inflammation in the body. 

 
RISK FACTORS: 

Risk factors are certain things which can increase the chances of you developing a disease. Some of the risk factors for arthritis can be environmental, this includes smoking which can develop or exacerbate arthritis issues. This is due to chemicals within tobacco products which have been evaluated as harmful. Smoking is possibly related to a genetic context and plays a specific role in triggering a certain subtype of rheumatoid arthritis (RA) due to its effect on certain types of arthritis. Obesity, infection, and joint injuries are also possible risk factors for arthritis. 

 
COLD WEATHER AND RA AFFECTION: 

 
Previous studies have suggested that seasonal changes can have impacts on RA. Onset of RA is more likely during the winter than summer specifically in the northern hemisphere and working in a cold environment can increase the chances of developing RA (2). This can cause issues with our joints that are painful and uncomfortable to deal with, as mentioned before synovial fluid exists between our joints and can act as a shock absorber, its normal texture enables easy and uninhibited joint movement. However, during colder weather this synovial fluid can become thicker which causes our joints to stiffen which stops people with RA from being able to move as freely. Your nerves also become more sensitive, the effects of scarring or inflammation from conditions such as RA can also be worsened causing joint pain to be felt as the temperature drops.  

This pain can be quite hard for individuals who already have synovial membrane inflammation. Other suggested theories for seasonal effects on RA include a drop in barometric pressure (a measurement of the air pressure in the atmosphere) during winter, this can result in tendons, muscles, and other tissue around joints to expand causing pain due to the constricted space within our bodies. This may affect everyone but especially causes issues in individuals affected by RA and other forms of chronic pain. Winter months can also mean less sunlight resulting in a reduction of vitamin D levels, 76% of patients with RA have also been deficient in vitamin D, which may contribute to the worsening of the disorder due to Vitamin D’s immunologic activities, which prevent inflammation through suppressing the production of inflammatory cytokines including the IL-6 which can be observed in RA patients (3). Please visit our shop if you need to use Vitamin D supplements, https://mundushealth.com/supplements/.

 
TREATMENT

 
Here are some ways we can help mitigate the issue of RA during cold weather and deal with it regardless of its cause. 
• Weight loss: This is due to larger amounts of weight putting extra stress on joints which support it, losing weight can increase how mobile you are and reduce the chance of joint injury in future. 
• Exercise: Regular exercise can keep your joints flexible. Recommended exercises include swimming and water aerobics due to them being in water, at home exercises can also be useful. For home exercises we advice to check out the training section in shop with very useful tools (resistance bands, dumbbells etc.) and get the best results, https://mundushealth.com/training/.
• Devices: Canes, walkers and shoe inserts are devices which can be helpful to help lessen the stress on joints. 
• Temperature treatment: Thermotherapy is useful as a form of palliative therapy and 
can be useful alongside exercises for treatment of RA patients (4). 
• Clothing: Dress in layers to ease the cold weather’s effect on your body. 
• Rest: Having a good night’s sleep, positive mindset and good diet can be useful for 
combating the pain being experienced. 

Seeing a Physiotherapist can be useful after you have been diagnosed with RA. The 
physiotherapist will assess your joints and muscles to see how you perform functional activities. Once completed the physiotherapist will go through what they have found a create a plan to manage the disorder with you, which can include information on managing a flare, when to exercise and rest and advice on modifying activities to protect your joints. In conclusion it can be difficult dealing with arthritis and joint pain especially when exacerbated by colder weather, methods above are quite effective for mitigating the pain however the most recommended solution would be going through the pain with a Physiotherapist. 

 
References: 

  1. Conforti, A., Di Cola, I., Pavlych, V., Ruscitti, P., Berardicurti, O., Ursini, F., Giacomelli, R., & Cipriani, P. (2021). Beyond the joints, the extra-articular manifestations in rheumatoid arthritis. Autoimmunity reviews, 20(2), 102735.  
  1. Mori, H., Sawada, T., Nishiyama, S., Shimada, K., Tahara, K., Hayashi, H., Kato, E., Tago, M., Matsui, T., & Tohma, S. (2019). Influence of seasonal changes on disease activity and distribution of affected joints in rheumatoid arthritis. BMC musculoskeletal disorders, 20(1), 30.   
  1. Reham Najim ABD, Majid Mohammed Mahmood, Asaad F AlbayatiSeasonal Fluctuations of Inflammatory Cytokines in Rheumatoid Arthritis Iraqi Patients, J Res Med Dent Sci, 2021, 9 (8): 335-338.  
  1. Robinson, V., Brosseau, L., Casimiro, L., Judd, M., Shea, B., Wells, G., & Tugwell, P. (2002). Thermotherapy for treating rheumatoid arthritis. The Cochrane database of systematic reviews, (1), CD002826. 

Article reviewed by Cosimo Simeone — Scientifically written by Osiah Ndlovu,  

                          Division of Neuroscience at Keele University — 

                                        Updated on March 7, 2023 

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