Weather Conditions Show Limited Influence on Musculoskeletal Pain Symptoms

Weather changes are often described by patients with musculoskeletal conditions, including rheumatoid arthritis (RA) and gout, as a significant trigger for symptom onset or exacerbation of musculoskeletal pain.¹

However, a recent systematic review with meta-analysis of case-crossover studies found changes in weather did not appear to elevate the risk of musculoskeletal symptoms, including knee, hip, or low back pain. On the other hand, the analysis revealed high temperatures in combination with low humidity increased the risk of recurrent gout attacks by two-fold.

“Although changes in weather conditions are frequently described by patients as triggers for pain and other symptom exacerbation, they do not appear to be significant risks of knee, hip, low back pain, or headache exacerbation, and have a small influence in symptom exacerbation of gout disease,” wrote the investigative 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 health conditions and adverse health events.² Close to two-thirds of individuals with knee, hip, or hand osteoarthritis have reported their pain to be affected by the weather. Despite these frequent endorsements, prior research has not provided a definitive answer on the association between weather and musculoskeletal pain.¹

Ferreira and colleagues performed 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 to determine the risk of an event associated with transient exposures, such as climate events. As participants are compared with 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 evaluated the risk of symptom onset or exacerbation and weather parameters (temperature, relative 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 episodes of pain occurrence, exacerbation, or flares.

The search identified 1107 case-crossover studies, of which 11 studies investigating the effect of weather on symptom development or exacerbation were included for review. All 11 studies came together for 15,315 participants reporting 28,010 events for seven musculoskeletal conditions, compared with 102,536 control periods. Overall, the pooled analyses 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 assessing the risk of OA or gout flares associated with increasing categories of air temperature showed no significant risk of musculoskeletal pain (odds ratio [OR], 1.01; 95% CI, 0.84 to 1.18). Further, three pooled studies assessing the risk of OA or gout flares with increasing humidity similarly identified no significant risk of pain (OR, 1.1; 95% CI, 0.96 - 1.24).

However, in multivariate analysis, temperatures higher than 70 degrees Fahrenheit, combined with low humidity (<60%), in the past 48 h, were associated with increased pain, redness, and joint 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 the study discussion, Ferreira and colleagues suggested the discrepancy between gout flares and other musculoskeletal events may be explained by biological mechanisms underpinning each disease and their relationship with weather parameters.

“It is possible that warm and dry weather may lead to dehydration, increased uric acid concentration, and increased crystal deposition in people with gout, resulting in increased risk of gout flares,” Ferreira and colleagues wrote.

References

1. _{Ferreira ML, Hunter DJ, Fu A, Raihana S, Urquhart D, Ferreira PH. Come rain or shine: Is weather a risk factor for musculoskeletal pain? A systematic review with meta-analysis of case-crossover studies. Semin Arthritis Rheum. 2024 Jan 28;65:152392. doi: 10.1016/j.semarthrit.2024.152392. Epub ahead of print. PMID: 38340613.}
2. _{Timmermans EJ, van der Pas S, Schaap LA, et al. Self-perceived weather sensitivity and joint pain in older people with osteoarthritis in six European countries: results from the European Project on OSteoArthritis (EPOSA). BMC Musculoskelet Disord. 2014;15:66. Published 2014 Mar 5. doi:10.1186/1471-2474-15-66}