APLAR Journal of Rheumatology 2004; 7: 204206

ORIGINAL ARTICLE
Blackwell Publishing, Ltd.

Weather changes and pain in rheumatology patients

Weather changes and pain in rheumatology patients

Jennifer NG,1 David SCOTT,1 Ashish TANEJA,1 Peter GOW1 and Ashmita GOSAI2
1
Department of Rheumatology, Middlemore Hospital and 2National Institute of Water and Atmospheric Research, New Zealand

Abstract
Objective: Many rheumatology patients report exacerbation of joint symptoms with weather changes.
We report the first of a two-part study on the influence of weather on rheumatological conditions. This survey
aims to describe perceived weather sensitivity in our patient population.
Methods: Two hundred rheumatology patients seen consecutively in a tertiary hospital were given a 10-item
questionnaire (Jamieson). This questionnaire has been well validated with good test-retest reliability (r = 0.91)
and ability to distinguish patients with weather sensitivity. New patients and soft tissue clinic patients were not
included.
Results: Seventy-four percent of patients reported weather sensitivity, with humidity and low temperature
reported most frequently as being associated with worsening of symptoms (66% and 72%, respectively). Seventy
percent of weather sensitive subjects described pain exacerbation prior and/or during weather changes. Various
rheumatological conditions had similar rates of weather sensitivity, except fibromyalgia which reported 100%
weather sensitivity.
Conclusion: A significant proportion of rheumatology patients report weather sensitivities. Further studies
would be useful to further explore actual versus perceived effects of weather as this may have behavioural,
housing and medical implications. Our discussion includes a brief summary of current literature and various
postulates why patients may have increased weather sensitivity.
Key words: arthritis, barometric pressure, pain, rheumatology, weather sensitivity.

INTRODUCTION changes and pain have been conflicting.69 Studies are

Hippocrates (in approximately 400 BC) noted that many
illnesses were related to weather changes.1 Anecdotes
concerning the influence of weather with arthritis symp-
toms are plentiful with many patients in rheumatology
clinics reporting pain exacerbation with changes in weather.
Interestingly, the Asian symbol for rheumatism (Fong
shi, see Fig. 1) is literally translated as wind and wet.
Despite this, there is paucity of scientific data exam-
ining this relationship. Some conditions such as rheu-
matoid arthritis, osteoarthritis and fibromyalgia appear
to be especially sensitive to weather changes.25 Investi-
gations studying the relationship with meteorological
Correspondence: Dr Jennifer Ng,
Email: JNg@middlemore.co.nz
often limited by small numbers, recall bias and short
follow-up periods.
The rheumatology department in Middlemore
Hospital, New Zealand is undertaking a study with the
National Institute of Water and Atmospheric Research
(NIWA), looking into the relationship between weather
changes and pain in rheumatology patients. We report
the first of a two-part study, which examines the per-
ceived association of weather changes and pain.
METHOD
We undertook a questionnaire-based survey of 200
patients seen consecutively among rheumatology out-
patients over July and August, 2003. New patients and
soft tissue clinic patients were excluded from the study.

Asia Pacific League of Associations for Rheumatology


Figure 1 Asian symbol for rheumatism (Fong shi or wind
and wet).
All patients were asked to complete a weather and pain
questionnaire. The questionnaire (Jamieson) had been
designed to detect weather-sensitive patients and has been
shown to have good test-retest reliability (r = 0.91).10
RESULTS
Two hundred patients were invited to take part in the
survey: 149 participated. Twelve questionnaires were
discarded due to incomplete or inconsistent replies.
Fifty-eight percent of patients were Pakeha (Cauca-
sian); 18% Pacific Islanders; 10% Maori; 4% Asians and
10% others. Sixty-eight percent of patients were female.
Ages ranged from 16 to 90 years with 56% between
ages 46 and 75. Diagnoses included; rheumatoid arthritis
(51%); osteoarthritis (16%); gout (15%); psoriatic
arthritis (10%); lupus (10%); fibromyalgia (8%); and
other inflammatory athritides (8%). Some patients had
more than one rheumatological condition.
The results of the questionnaire are summarized
in Table 1. Patients were also sub-classified under each
rheumatological condition and weather sensitivity was
approximately 6070% in all groups except fibromyalgia
where all patients reported weather sensitivity.
Due to the small numbers of patients, it is not possible
to estimate differences between different ethnic groups.
DISCUSSION
A number of theories exist to explain increased pain with
weather changes. Sensitized type 4 mechanoreceptors
in damaged joints may be irritated as a consequence of
marked decrease in atmospheric pressure with intensi-
fication of pain (e.g. when barometric pressure falls
rapidly before a storm.11 Another postulation is that
because tendons, muscles, bones and scar tissue are of
varied densities, differential expansions and contractions
due to atmospheric changes, results in pain at sites of
microtrauma.10,12
APLAR Journal of Rheumatology 2004; 7: 204206
Weather changes and pain in rheumatology patients
Table 1 Summary of responses to questionnaire
Yes (%)
Does change in weather affect your pain? 74%
If change in weather does affect your pain when
does your pain become worse?
a. before weather changes 43%
b. during weather changes 57%
c. after weather changes 17%
Which weather condition(s) affects your pain the most?
a. Damp/rainy 65%
b. Cold 72%
c. Hot 9%
d. Change in barometric pressures 8%
e. Change in temperature 30%
During what particular time(s) of year is your pain worse?
a. Winter 82%
b. Fall 10%
c. Spring 6%
d. Summer 10%
Some hypothesize that weather changes affect mood,
resulting in alteration of pain perception.13,14
Patients living in warmer and more stable climates
appear to be similarly afflicted. In other words, it is the
changes in weather that result in pain exacerbation.
This was demonstrated in a study where 558 patients
from four medical centres of different climatic and geo-
graphical regions had similar weather sensitivities.10
Our data shows that the majority of patients (74%)
perceive an exacerbation of symptoms with weather
changes. This was mostly correlated with humidity and
cold weather with the majority having exacerbations
before and during weather changes. All patients with
fibromyalgia described weather sensitivity. Our figures
are similar to studies done in the US.10,15 There are no
similar data available in Australasia.
Further studies are needed to investigate the relation-
ship in a more objective manner, as there are signi-
ficant therapeutic and social implications. Studies
should be targeted at the subsets of weather-sensitive
patients in a structured research protocol looking at
different variables of weather with correlation of pain.
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