After months of cold winter days, spring may seem like a welcome alternative. But spring brings its own challenges when battling rheumatoid arthritis (RA).
Autoimmune diseases are cyclical in nature. Symptoms will come and go, and maintaining remission can be difficult. This makes research that look into the impact of the seasons hard to untangle from the natural ebb and flow of RA symptoms. And, to complicate matters further, the types of longitudinal studies needed to perform this research are difficult to maintain and lead to most research being done via post-hoc analysis (after-the-fact). This can lead to differences in the conclusions drawn by researchers.
Spring Showers Bring May Flowers… Bring RA Symptoms?
A study published in 2007 in the Oxford journal, Rheumatology, aimed to understand both objective and subjective measures of the seasons on RA symptoms. The researchers conducted sessions every 6 months, one in the spring and one in the fall, for 5 years. In total, 1665 people with RA participated in the study. Subjective measures such as patient pain scores, disease activity scores (DAS 28), and patient and physician assessments of disease activity. Additionally, objective measures included C-reactive Protein tests (CRP), erythrocyte sedimentation rate (ESR), and rheumatoid factor (RF).
Using a statistical method, an analysis of variance (ANOVA), the researchers concluded that there were, “definite seasonal differences in RA patients, both subjectively and objectively. RA disease activity was higher in spring and lower during fall.”
In total, 10 different methods were used to measure disease activity and all but 1 showed significant increases in the spring. Interestingly, the one measure that did not show a significant change (and was actually higher in the fall) was the physician analysis of disease activity. The researchers could not explain this finding, but they did speculate that doctors may want to believe that the disease activity is more consistent over the year and rate the values accordingly. This is an interesting hypothesis and may also have implications for diagnosing RA in new patients.
All told, it is still hard to draw strong conclusions from this research. The researchers reported the following statement:
“The absolute differences between fall and spring were significant but minimal and may not truly reflect relevant clinical differences.”
Previous research on the spring season and RA
Despite this large study finding seasonal implications for RA, the previous literature was less decided on the topic. Some older studies that focused on similar measures to the study above, but reached different conclusions.
- Annual fluctuations in rheumatoid arthritis (1981)
- Retroactively analyzed ESR and CRP for 2,802 people with RA comparing results to the time of year when the study took place
- Finding: No statistically significant changes in score were found based on time of year
- ESR and CRP are important in the inflammation process. The researchers considered the possibility that changes in RA in the spring may be a result of some other mechanism
- Seasonal Symptom Severity in Patients with Rheumatic Diseases: A study of 1,424 Patients (2001)
- Participants completed the Seasonal Pattern Assessment Questionnaire (SPAQ). These scores were compared to other clinical measures of disease activity
- Findings: 50% of people reported that season changes exacerbated their symptoms. However, these assertions were not backed up by the other measures of disease activity. The researchers suggest that it is the perception of the disease activity that is changing but not the underlying disease activity.
Initial season for symptom onset
A 2009 study took a different approach and examined if the season of initial symptom onset when RA began impacted outcomes. The researchers used the modified Total Sharp Score (mTSS), which measures the spacing in the joints and looks for erosion of tissues.
The researchers concluded that people who have initial symptom onset in the winter months have a worse prognosis (measured at 6 months) than those that had symptom onset in the summer. And, those with spring symptom onset experienced worse radiographic outcomes as compared to those with summer onset.
So what’s it all mean?
Unfortunately, it is hard to extract meaningful treatment plans based on the season differences reported in these studies. It is possible to take solace in the fact that many autoimmune warriors struggle with season change — and it wouldn’t be the first instance in dealing with RA when the clinical findings for symptoms are difficult for clinicians to explain.
Despite this, it is always good to review things you can do at home to help keep RA in check!
- Stay warm and care for your joints with ointments or lotions
- Work out – but don’t overdo it
- Eat well and try to limit your sugar intake