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Manuela L. Ferreira, PhD
Credit: University of Sydney
Patients with musculoskeletal conditions, including rheumatoid arthritis (RA) and gout, often describe weather changes as a major trigger for symptom onset or exacerbation of musculoskeletal pain.1
However, a recent systematic review with meta-analysis of case-crossover studies found that changes in climate did not appear to raise the risk of musculoskeletal symptoms, including knee, hip, or lower back pain. On the other hand, the analysis revealed that high temperatures in combination with low humidity doubled the risk of recurrent gout attacks.
“Although patients frequently describe changes in weather conditions as triggering pain and exacerbating other symptoms, they do not appear to be significant risks for exacerbation of knee, hip, low back pain, or headache pain, and have a small influence in the exacerbation of symptoms. gout disease,” wrote the research team led by Manuela L. Ferreira, PhD, Faculty of Medicine and Health, Sydney Musculoskeletal Health, The Kolling Institute, The University of Sydney.
Changes in temperature, air humidity, and barometric pressure are frequently associated with an increased risk of chronic diseases and adverse health events.2 About two-thirds of people with osteoarthritis of the knee, hip or hand have reported that the weather affects their pain. Despite these frequent endorsements, previous research has not provided a definitive answer regarding the association between climate and musculoskeletal pain.1
Ferreira and colleagues conducted a systematic review and meta-analysis of all case-crossover studies in the field to challenge the limitations of previous reviews. They noted that case-crossover studies are the gold standard methodology for determining the risk of an event associated with transient exposures, such as weather events. As participants are compared to themselves, the case-crossover design allows for a well-matched control window when the participant did not experience the event, minimizing the risk of bias.
Two independent reviewers searched MEDLINE, EMBASE, CINAHL, Web of Science, Scopus, and PsycINFO from inception to August 2023. Published case-crossover studies were included for analysis if they assessed the risk of symptom onset or exacerbation and climatic parameters (temperature, relative temperature). humidity, air pressure, and precipitation) in adults with musculoskeletal conditions (low back pain, osteoarthritis, RA, and gout). The primary outcome of interest for the analysis was pain measured as new onset, exacerbation, or exacerbations of pain.
The search identified 1107 case-crossover studies, of which 11 studies investigating the effect of climate on the development or exacerbation of symptoms were included for review. The 11 studies included 15,315 participants who reported 28,010 events for seven musculoskeletal conditions, compared with 102,536 control periods. Overall, pooled analyzes revealed no association between relative humidity, air pressure, temperature, or precipitation and the risk of RA, knee pain, or low back pain.
Three pooled studies evaluating the risk of OA or gout attacks associated with increasing air temperature categories showed no significant risk of musculoskeletal pain (odds ratio [OR], 1.01; 95% CI: 0.84 to 1.18). Furthermore, three pooled studies evaluating the risk of OA or gout attacks with increasing humidity also did not identify any significant risk of pain (OR, 1.1; 95% CI, 0.96 – 1.24).
However, in multivariate analysis, temperatures above 70 degrees Fahrenheit, combined with low humidity (<60%), in the past 48 hours were associated with increased joint pain, redness, and swelling among people with gout (OR, 2.04; 95% CI, 1.26 to 3.30). Both changes in barometric pressure and precipitation did not affect the risk of musculoskeletal symptoms.
In discussing the study, Ferreira and colleagues suggested that the discrepancy between gout flares and other musculoskeletal events may be explained by the biological mechanisms underlying each disease and their relationship to climatic parameters.
“It is possible that hot, dry weather may cause dehydration, increased uric acid concentration, and increased crystal deposition in people with gout, resulting in an increased risk of gout attacks,” Ferreira and colleagues wrote.
References
- Ferreira ML, Hunter DJ, Fu A, Raihana S, Urquhart D, Ferreira PH. Rain or shine: Is the weather a risk factor for musculoskeletal pain? A systematic review with meta-analysis of case-crossover studies. Semin rheumatic arthritis. January 28, 2024; 65: 152392. doi: 10.1016/j.semarthrit.2024.152392. E-publishing ahead of print. PMID: 38340613.
- Timmermans EJ, van der Pas S, Schaap LA, et al. Self-perceived climate sensitivity and joint pain in older people with osteoarthritis in six European countries: results from the European Project on OsteoArthritis (EPOSA). BMC musculoskeletal disorder. 2014;15:66. Published March 5, 2014. doi:10.1186/1471-2474-15-66