Season of gloom and pain

Dr Mandeep S Dhillon

Frost, cold winds and dismal evenings are not the only problems we have to brave in winters. The chilly weather aggravates certain health conditions as well. These winter ailments are worse than summer ills like pollen-related asthma or sinus infection, or the sunburn. 

The gloomy, dark days of winter not only cause depression, but cold weather raises the risk of heart attacks and many bone and joint-related problems. The cold temperature is known to cause joint pains, and arthritis patients often end up dreading the cold nights. However, help is at hand with heat packs or hot showers as these can relax the muscles around the joints and relieve stiffness and pain, according to Dr Kelly Weismman, a US rheumatologist. Pain occurs on extremely cold nights as ligaments and muscles get stiff. 

The joints have been documented to react to weather changes; flaring up of rheumatism has often been seen as a forewarning of rain. In a study conducted by Robert Jamison at Harvard, 67.9 per cent people “were sure weather changes effected their pain”. This was attributed to a change in barometric pressure by the researcher, who explained  “as tissue expands, it puts more pressure on nerves that control pain signals”. Others attribute this to an inflammatory response which changes circulation and possible nerve fibre sensitivity.

Despite the fact that the causes are debatable, cold weather invariable increases discomfort; senior citizens confirm that their “problems” are always compounded during the winter. In winters a large number of patients complaint of significant increase in pain in weight-bearing joints, in addition to neck/back pains, which may not be such a serious issue on its own in warmer climes.

So what should be done to increase comfort? Patients from colder climes like Himachal Pradesh often inquire if shifting to warmer climes will decrease their pain; the answer is “no”. Relocating to warmer climes does not seem to make a long-term difference. Scientific studies have shown that no matter where people live their bodies seem to establish a new equilibrium to the local climate. As a result, changes in the weather affect the arthritis symptoms in the same manner regardless of the actual overall average weather. Shifting residence is not likely to be beneficial in the long term. Even warmer states like Rajasthan have such patients.

However, only joint symptoms (such as pain and stiffness) are influenced by weather. Though this is not true for all arthritis patients, nor is it predictable what type of weather alterations will bother people. Some patients complain of aching joints during cold and wet weather, while for other patients, pain gets worse a few days after the cold spell is over. Even doctors are often confused with this diverse information input. The bottom line is that while the exact cause(s) of the activation of arthritis symptoms may not yet be scientifically understood, each patient must make lifestyle and/or medication adjustments according to the particular weather conditions that they note influence their symptoms.

Another question frequently asked is whether the disease itself actually worsens with cold and wet weather. This is untrue, as there is no evidence that weather changes lead to joint damage, nor is there any relationship between weather changes and whether or not an individual develops arthritis. 

However, some problems can worsen with climatic changes. Cramping of muscles increases during winter months, when people exercise without adequate warm-up. 

Raynaud’s phenomenon is a condition that results in finger or toe discoloration when the patient is exposed to changes in temperature (cold or hot) or emotional events. Skin discolouration occurs because of abnormal blood vessel spasm causing diminished blood supply; these patients should minimise their exposure to extremes temperatures, as even chill blains can occur.

So what precautions should we take in winters? According to the Arthritis Foundation of WA (Western Australia), dressing warmly, with layering of clothes is the key. It is best to keep the head, hands and feet covered warmly, as majority of heat is lost from the body’s extremities. Cold weather also alters people’s exercise plans; walks are reduced, and outdoor activities either stop or reduce, as we all have an instinct to ‘hibernate’. However, lack of physical activity compounds the problem and causes stiffer joints. Exercise in winter eases arthritis pain. It also increases strength and flexibility, reduces joint pain and helps combat fatigue. However, it is important to modify your exercise schedules; it is best to exercise indoors. Dance or yoga are good options. Remember exercise doesn’t have to be boring; anything that keeps you moving works. We just have to tide out the short winter spells in any region we live. Maybe P.B. Shelley’s immortal words can provide sustenance “If winter comes, can spring be far behind”?

—The writer is professor and head of orthopaedics, PGIMER, Chandigarh