Joint Disease and Winter Don't Mix

The fall’s first frost usually happens in mid-November, but if you are not a “snowbird” and don’t plan to head to Florida, you may already be worried about dealing with your rheumatoid arthritis this winter. If you associate the winter season with more joint pain, you are not alone. Nevertheless, there are some things you can do.

What is rheumatoid arthritis (RA)?

Unlike osteoarthritis (OA), which is more common as it is due to the wear and tear on aging joints, rheumatoid arthritis is an autoimmune disease. This means the immune system mistakenly attacks itself. For some people with RA it may be genetic, and infections and hormones may also play a role. It is more common in middle-aged women, though RA can occur at any age, and it is serious. If not treated, over time, joints may become permanently damaged, resulting in a loss of range of motion and even deformities. In addition, the persistent inflammation may start to affect other areas of the body, such as the heart, lungs and nervous system.

What are the Symptoms?

Initially, the symptoms may be mild, with minor joint pain, swelling, as well as fatigue. It may start in the small joints of the hands and feet, then can involve the larger joints. RA usually affects the right and left side of the body at the same time. As the disease progresses, mornings can get more difficult. Stiffness upon waking can be brutal and last more than an hour. Joints may be painful, swollen and tender while resting.

These painful symptoms may actually get worse in the winter and there are some theories about why that happens. Although nothing has been proven directly, one thought is that when it is cold outside, the nerves and blood vessels are more likely to constrict in the extremities as the body attempts to keep our inner core – heart and organs – warmer. This constriction causes less blood flow to the limbs, which in turn may cause more joint pain due to the increased stiffness. Another theory is that colder weather generally makes people less active and this immobility tends to make arthritis symptoms worsen.

Diagnosing RA

Rheumatoid arthritis is diagnosed by a physical exam, checking symptoms, blood tests to detect antibodies and radiographic imaging. The features of joint symptoms often help distinguishing between different types of arthritis. Antibody testing and inflammatory markers are important in making a diagnosis, however, it’s important to note that there may be false positives. Your exam and clinical history are very important in determining source of pain. X-rays, ultrasounds, and MRI studies may be helpful, but not always necessary, and may be normal early on in the course of the disease. Onset and length of joint pain are also important to consider.

Treatments for RA

Once a diagnosis is made, depending on the severity of the disease, other medical history, and functional status, a disease-modifying anti-rheumatic drug (DMARD) is started. This may include a combination of oral or biologic medications. Some examples of oral drugs include Methotrexate, leflunomide, sulfasalazine, and hydroxychloroquine.

Biologics are medications that target a specific part of the immune system to calm down inflammation and reduce joint damage. These include abatacept, adalimumab, certolizumab, etanercept, golimumab, infliximab, rituximab, sarilumab, tocilizumab. Another targeted group of medications for rheumatoid arthritis are the Jak Kinase inhibitors, which are oral medications that include baricitinib, tofacitnib, and upadcitinib and may be used in more severe disease.

The goal of treatment is not only to reduce pain and swelling, but also reduce the progression of the disease and joint damage. Sometimes non-steroidal anti-inflammatories (NSAID) or corticosteroids may be used to help bring down swelling or during flare-ups. Compliance to medication, regular monitoring blood work, and periodic radiologic imaging are all very important in preventing disease flare-ups, as well as monitoring the overall arthritis and other possible organ involvement.

What else can you do?

Treating rheumatoid arthritis, as well as with other autoimmune diseases, is not just about medications. It is important to follow-up with your rheumatologist and primary care doctors, especially since other areas of your body may also become involved. Regular exercise that include low-impact aerobic workouts and muscle strengthening exercises are important in preserving overall health and range of motion. Discussions with your rheumatologist, physical therapist, and occupational therapist can be helpful in determining the right exercise plan for you.

Remember: It’s imperative to stay active even when it is cold outside. Hot morning showers are arthritis patients’ best friends and will help you get moving earlier in the day, before it gets too dark and you lose motivation to go outside at all. When venturing out in the wintertime, make sure to dress with socks and gloves that are warm, yet easy to get on and off, with velcro or larger zippers on coats. And keep in mind that people with rheumatoid arthritis may have a higher risk of weaker bones, so falling on ice is especially dangerous. Treaded winter footwear can help with slippery sidewalks.

If you prefer to exercise indoors, treadmills may be a good option. Swimming in heated pools during the winter can be great exercise and stress relieving. So can a walk in an indoor mall, like the one at Columbus Circle, for example. Gentle yoga, massage, and acupuncture may also help relieve the chronic pain that can be associated with RA.

Jessica Patel, MD, is an Assistant Professor of Medicine (Rheumatology) at Mount Sinai St. Luke’s and Mount Sinai West.