- Call a doctor immediately if you have rheumatoid arthritis and experience these symptoms
- Worsening of joint symptoms
- Lack of improvement of joint symptoms
- RA Progression: What are the Signs of Rheumatoid Arthritis Progression?
- When to Seek Treatment
- Can Weather Make Your Joints Ache?
- Some arthritis sufferers think so, but experts are iffy
- Cold Weather Joint Pain: 15 Tips for Managing It
- 1. Bookmark the ‘Aches & Pains’ weather map
- 2. Take your meds in bed
- 3. Invest in a programmable thermostat
- 4. Use heated mats strategically in your home
- 5. Give yourself a massage
- 6. Wrap your hands in compression gloves
- 7. Talk to your doctor about adjusting your medication
- 8. Bring the heat with chili peppers
- 9. Buy a really good snowsuit
- 10. Sip a mug of golden milk
- 11. Do a home paraffin wax treatment
- 12. Make yourself a ‘hot pocket’ in bed
- 13. Wear supportive splints
- 14. Break out your yoga mat
- 15. Soak up the heat in a sauna or hot tub
- Not Sure What’s Causing Your Pain?
- Keep Reading
Call a doctor immediately if you have rheumatoid arthritis and experience these symptoms
Doctors themselves, or with “call partners,” cover urgent medical concerns for their patients when the office is closed.
People with rheumatoid arthritis can develop certain symptoms that are really warning signs of something occurring in their bodies that is not what the doctor expects to happen. These are signs that can also sometimes represent a significant danger. These “rheumatoid warning signs” are reasons to call the doctor so that they can be interpreted in light of the patient’s overall condition. When the doctor who is aware of your condition hears of these symptoms, he/she can determine whether or not they are serious and if any action should be taken immediately or in the near future.
Rheumatoid warning signs can represent a worsening or complications of the rheumatoid disease, side effects of medications, or a new illness that is complicating the condition of patients with rheumatoid arthritis. Patients with rheumatoid arthritis should be aware of these rheumatoid warning signs so that they can contact their health care professional before their health is jeopardized.
Here are some warning signs that I like my patients to call me about.
Worsening of joint symptoms
This includes more pain, more swelling, additional joint involvement, redness, stiffness, or limitation of function. The doctor will determine whether or not these are significant, not the patient. Sometimes, patients have just begun a medication and some minor increase in joint problems might be occurring while the medication is taking effect. However, worsening symptoms can also mean that the medications are not working and that they require adjustments in dosing or a change in the medications.
Lack of improvement of joint symptoms
One major purpose of seeing the doctor is to get better. The doctor knows this. If a patient with rheumatoid arthritis has seen the doctor and is started on a treatment program and is not showing improvement but is worsening, notification of the doctor is appropriate. After starting a new treatment program, it sometimes takes time for the medications, physical therapy, etc., to control the inflammation. It is up to the doctor to decide if things are on course.
A mildly elevated temperature is not unusual in a person with active inflammation from rheumatoid arthritis. However, a true fever (temperature is above 100.4 F or 38 C) is not expected and can represent an infection. People with rheumatoid arthritis are at increased risk for infection because of their disease and frequently because of their medications. Many of the medications used to treat rheumatoid disease suppress the immune system of the body that is responsible for defending against infectious microbes. Furthermore, these medications can increase the risk of a more serious infection when a bacterium or virus strikes. It is important for people with rheumatoid arthritis to notify the doctor as soon as a fever occurs so that infections are treated at the earliest time possible. This can minimize the chances for many serious complications of infections.
RA Progression: What are the Signs of Rheumatoid Arthritis Progression?
Keep in mind that what works for some patients may not work for you. Your response to treatment is largely dependent on the potential factors that triggered your RA, including genetic background.
Symptoms of Progressive Rheumatoid Arthritis
Here are some general warning signs and symptoms that you may have developed progressive rheumatoid arthritis:
• The “active” state of the disease is becoming more frequent
• Flare-ups are occurring regularly and lasting for longer periods of time
• Your pain and swelling are becoming more intense, spreading throughout other areas of your body
• Your diagnosis occurred early on, and so the disease has had a long time to develop
• You are beginning to develop rheumatoid nodules that you didn’t have before
• Your blood tests show high levels of Rheumatoid Factor (RF) or anti-CCP
If you suspect that your rheumatoid arthritis has become progressive, consult your rheumatologist to determine the changes in your condition and discuss potential adjustments to your treatment plan.
When to Seek Treatment
The following are general guidelines of when to seek treatment for your RA progression:
• When you first suspect symptoms
• Regularly during the first few years of diagnosis
• If you suspect you are experiencing progressive rheumatoid arthritis
• If you feel your condition is worsening in any way or new symptoms appear
While it is difficult to prevent the disease itself due to its unknown causes, RA progression can be managed. The ultimate goal is to stop symptoms from worsening and to prevent the disease from advancing through its stages.
If you undergo individualized, targeted and aggressive treatment early in your disease process, you are more likely to delay and possibly prevent the progression of RA. Working closely with your physician to determine the specific stage of your condition will help to create a unique treatment plan for you for each stage.
Symptoms of rheumatoid arthritis (RA) don’t stop at joint pain and swelling. Most people with RA also experience mental and physical exhaustion, a symptom known as fatigue. Studies show that up to 80% of people with RA have at least some sense of feeling run down, and more than 50% have high levels of fatigue.
Terence Starz, MD, a rheumatologist at the University of Pittsburgh Medical Center, says the feeling can be described as overwhelming or different from just being tired because it is extreme and seems to come from nowhere. In fact, fatigue may have a greater impact on daily life than pain.
Causes of Fatigue
You may expect disease activity and high levels of inflammation to cause your fatigue. It’s true they account for much of it, but recent studies have shown that these factors don’t tell the whole story. A 2016 study published in Rheumatology found that even when people are in clinical remission, they can still have significant fatigue.
If it’s not disease activity, what else could be causing your fatigue? In a study published in Arthritis Care & Research in 2016, Patricia Katz, PhD, professor of medicine at University of California San Francisco, and her colleagues found that “fatigue may result from a constellation of factors that includes disease activity and pain, but also includes inactivity, depression, obesity and poor sleep.”
Pinpointing which factors cause fatigue and which are a result of fatigue is difficult. Katz says the relationships may be cyclic: “Fatigue may lead to inactivity and depression; then the inactivity worsens fatigue, depression and poor sleep.”
Fatigue can be overwhelming, but you don’t have to accept your crushing exhaustion. Medications and lifestyle habits can alleviate your fatigue and boost your energy.
How Your Doctor Can Help
Eric Ruderman, MD, professor of medicine at Northwestern University Feinberg School of Medicine in Chicago, says “a comprehensive disease management program will help control inflammation, disease activity, pain and fatigue.”
“As disease activity decreases, usually, so will fatigue. Controlling inflammation through early and aggressive treatment is essential for your long-term well-being,” Dr. Ruderman explains. If you have successfully treated your disease activity, but you still have significant fatigue, you may need to target other factors that influence your fatigue levels.
Your doctor can prescribe a variety of medications to help control the pain of RA and the secondary osteoarthritis that may develop. These medications include acetaminophen, nonsteroidal anti-inflammatory drugs, topical pain relievers, corticosteroids (injected into individual joints or taken orally) and hyaluronic acid injections.
If you have fibromyalgia and RA, your doctor may prescribe antidepressants or anti-seizure medications to help control your centralized pain.
Dr. Ruderman says opioids are not the best option for most people with RA because opioids should generally be avoided for long-term use.
Fatigue, depression and RA often go hand-in-hand with one making the others worse. Dr. Ruderman explains depression can be a brain chemical issue that may require consultation with a psychiatrist and possibly antidepressant medications. For milder cases, some rheumatologists are comfortable prescribing these drugs. When taken in low doses, they can also help ease pain.
Sleep aids can help you get more restorative sleep, helping both pain and fatigue. But Dr. Ruderman says not to rely on them. It’s important to engage in daytime physical activity and practice good sleep hygiene. “The newer medications can be used as a last resort, but I try to avoid the older sedatives,” he says.
What You Can Do
Because fatigue in RA is multifactorial, you shouldn’t rely on medications alone to alleviate your drained feeling. These lifestyle habits can help increase your energy.
Activity and Exercise
Besides controlling your underlying inflammation and disease, probably the most important thing you can do to lessen your fatigue is to get moving! If you’re exhausted, the last thing you want to do is exercise. But studies show that increasing your activity level will improve your fatigue.
Katz presented a study at the 2015 American College of Rheumatology annual meeting that showed giving a person with RA a pedometer and some modest step goals improved physical activity and decreased fatigue. “Results suggest that increasing physical activity by prescribing a pedometer can be effective for reducing fatigue,” Katz says, “particularly among individuals with very low activity levels initially.”
Poor sleep can significantly affect your pain and fatigue. Dr. Starz recommends several non-drug steps to improve your sleep, including developing a ritual with a stable bedtime; sleeping in a cool, dark room; limiting caffeine; and turning off electronics at least an hour before bed.
You may need to adapt your activities and lifestyle when your fatigue is at its worst. Find balance by giving yourself periods of rest and plenty of sleep. Dr. Starz says, “Thoughtful planning, prioritization and pacing of your daily activities should be your guiding principles.”
Hot and Cold Therapies
Cold packs slow blood circulation, which can help reduce inflammation and pain. Warm baths or compresses improve blood flow and relax sore muscles, which can ease your pain and stiffness.
Cognitive behavior therapy, meditation, yoga, tai chi and other therapies work on the connection between your mind and body. Harnessing this connection can help reduce fatigue, improve mood and energy, and reduce pain.
Katz’s studies show that people with RA who are obese are more fatigued than patients of a healthy weight. So achieving and maintaining a healthy weight may help reduce your fatigue levels.
Drs. Ruderman, Katz and Starz agree about the best overall tactic to take to fight fatigue: Control your underlying disease and “move more, sit less.”
- How to Beat Fatigue
- Studies Show Fatigue Persists Even When Rheumatoid Arthritis is Controlled
- Eight Ways to Fight Fatigue with Food
- Can a Pedometer Help Fight Rheumatoid Arthritis-Related Fatigue?
Can Weather Make Your Joints Ache?
Some arthritis sufferers think so, but experts are iffy
Remember that aunt who claimed her aching joints signaled a storm front on the horizon?
Many rheumatoid arthritis sufferers have long believed that cold, damp conditions or changes in barometric pressure can aggravate their symptoms, which can include pain, stiffness and swelling of the joints.
But despite a fairly large number of studies examining the impact of weather on problems related to rheumatoid arthritis, results remain inconclusive, says Andrew Ruthberg, MD, a rheumatologist at Rush University Medical Center.
“I don’t think there’s any strong answer to the question,” he says.
Rheumatoid arthritis is an autoimmune disease that frequently targets wrists, fingers, knees, feet and ankles. While we know it can occur in people of all ages, and that it affects more women than men, the precise role of weather remains up in the air.
Studies look at perception vs. reality
In one study of rheumatoid arthritis sufferers, participants were asked directly if weather affected their condition. And, perhaps not surprisingly, many said that yes, in fact, it does.
“A lot of people perceive weather as having an effect on their condition,” says Ruthberg. “Most of the time people will complain that colder weather or damper weather makes them feel worse than sunnier, warmer, drier weather.”
Since perception doesn’t necessarily equal reality, researchers have approached it from another angle and had people keep diaries about their pain or stiffness over a month or longer, then matched the reports up with official weather data.
“Some of them have shown some correlation, but it hasn’t been seen in every single study, and it has not been shown to be just a huge, huge factor,” Ruthberg says.
A 1960 study did lend some support to a weather connection. After University of Pennsylvania researcher Joseph Hollander monitored 12 arthritis patients in a climate-controlled chamber over several weeks, most, he said, felt worse when they were subjected to a combination of increased humidity and falling barometric pressure.
See a doctor
Whether or not weather makes a difference, you don’t have to suffer in silence.
Rheumatoid arthritis is a treatable disease, and Ruthberg advises seeing a rheumatologist if you are experiencing symptoms that may indicate you have rheumatoid arthritis. Those symptoms may include joint pain and swelling, noticeable morning stiffness and fatigue.
A variety of treatment options can help alleviate symptoms and/or limit damage to joints, including the following:
- Physical therapy and exercise
- Simple anti-inflammatory medications, such as ibuprofen and naproxen
- Disease modifying antirheumatic drugs, ranging from methotrexate to the newest biologic agents
- Surgery for more severely involved joints If you are diagnosed with rheumatoid arthritis, a rheumatologist can advise you on the specific treatment approach that’s right for you.
If people ask me about moving, I caution them to be very careful about disrupting their entire life based on the hope that moving to another climate will make them a whole lot better.
One thing Ruthberg advises against: fleeing to the arid Southwest in hopes of easing arthritis pain.
“If people ask me about moving, I caution them to be very careful about disrupting their entire life based on the hope that moving to another climate will make them a whole lot better,” he says.
Plus, there’s no real scientific proof that warmer, drier climates make a difference. “I don’t think there’s a whole lot of difference in what would be called epidemiology when you look at the warmest, driest community in Arizona vs. a lakeside city in the Chicago area,” he says. “I don’t think we really know.”
If you’re seriously thinking of moving, Ruthberg suggests visiting a place first to see if it really makes a difference.
The Arthritis Foundation also notes that even if you’re certain a warmer, drier climate will make you feel better, any health benefits might be outweighed by having to leave behind your support system of family and friends.
Cold Weather Joint Pain: 15 Tips for Managing It
Does the temperature outside affect arthritis pain? It seems like such a simple question — but the answer is not. If you ask patients, many report that their symptoms worsen when outside temps drop yet existing science doesn’t seem to support or explain such a link. In fact, the Greek physician Hippocrates was asking this question 2,300 years ago and wasn’t able to come to a satisfactory conclusion so perhaps it’s not surprising that modern medicine hasn’t yet either. But that doesn’t mean scientists aren’t trying.
A coalition of researchers in the United Kingdom — a place with its fair share of cold, damp weather — decided to tackle this question by tracking people’s pain symptoms and seeing if they could correlate with cold and other weather patterns. Even within the project there was skepticism.
“Many people with arthritis believe that changes in the weather affect the level of pain they experience,” says Stephen Simpson, PhD, director of Research and Programs at Arthritis Research UK. “However, there is currently no scientific evidence to support this relationship.”
Yet lead researcher Will Dixon, PhD, director of the University of Manchester’s Arthritis Research UK Center for Epidemiology and an Honorary Consultant Rheumatologist at Salford Royal NHS Foundation Trust, feels there are answers to be found through technology.
Named Cloudy with a Chance of Pain, the project collected data from over 13,000 people from January 2016 until April 2017. Participants were asked to record pain and other symptoms every day on a phone app which then linked their reports with their local weather, based on the phone’s GPS. They are still analyzing the over 5 million data points but they do have some preliminary results and… they’re murky. For instance, in London, in June, the average temperature was 16 degrees Celsius (60.8 degrees Fahrenheit) and pain levels were a moderate 2.2. In December on a day that was 2.5 degrees C (36.5 F), the pain levels were down to 2.1. The data also reported that in February, on a day that was 3 degrees C (37.4 F), pain levels went up to 2.6.
Part of the challenge in studying how the weather affects arthritis stems from the many different factors involved, says Louise Cook, one of the researchers. It’s not just a matter of linking pain levels to a mark on a thermometer; you also have to take into account humidity, barometric pressure, and weather patterns that change hour by hour as well as whether the person is indoors or outdoors, whether other health conditions may also be causing pain, and how long it might take for the “cold” effect to kick in, she explains. However, their early data analysis does seem to show some correlation between poor weather conditions and increased pain, she says.
Previous research findings have been mixed, with some showing no connection between cold temps and arthritis pain while others showed some causal effect.
But regardless of what the science says, your personal experience — your study of one, if you will — is the most important factor for you, Dr. Dixon says. If the cold weather seems to make your arthritis pain worse (a feeling shared by many, many people), here are some things you can do to help you cope.
1. Bookmark the ‘Aches & Pains’ weather map
Changes in barometric pressure appear to be the main link between weather and pain, according to weather service Intellicast. “Low pressure is generally associated with cold, wet weather and an increase in pain; clear, dry conditions signal high pressure and a decrease in pain,” they explain. To help people who are sensitive to these changes, they keep an interactive Aches & Pains weather map that shows weather patterns in your area and how they might affect your pain levels.
“I might as well be a weather person, I’m so sensitive to changes,” says Charlene G., 37, who has rheumatoid arthritis. “I can tell you without even looking if it’s snowing.” Knowing in advance helps her plan out her day so she’s made the map her homescreen on her computer and checks it every morning.
2. Take your meds in bed
Crawling out of a warm, cozy bed on a cold day is no fun. Add in arthritis pain and it can be pure torture. Keep your daily arthritis and pain medications within reach of your bed. “I keep all my medications and a fresh bottle of water on my bedside table so all I have to do is reach over and take them,” says Amy K., 42, who has ankylosing spondylitis. You can even try to sneak in an extra bit of sleep in the morning while you wait for them to kick in.
Here are more tips to soothe morning stiffness and pain with arthritis.
3. Invest in a programmable thermostat
“For me it isn’t so much the cold that causes flares, it’s huge temperature fluctuations, like when it’s 80 degrees one day and 50 the next,” says Amy S., 26, who has psoriatic arthritis. To help keep her environment a consistent temperature, she had a programmable thermostat installed that lets her see the current temp and tweak it with much more precision than a traditional thermostat. “I also moved my bed away from the window to avoid cold air coming in that way,” she adds.
4. Use heated mats strategically in your home
Nothing helps soothe arthritis pain like heat, so place some heated mats around your home in places where you spend a lot of time, recommends Peter P., 56, who has osteoarthritis and gout. Heated mats work like electric blankets but they’re more portable and made to be stood on, so they warm up your feet and leg joints from the bottom up. “I have one right by my bed and I turn it on before I get up,” he says. “Without it I can’t even walk to the bathroom on cold mornings.” He also keeps one by the couch in his living room and under the table in his kitchen.
5. Give yourself a massage
Cold weather can cause muscles to tighten up, increasing pressure and pain in inflamed joints. Self-massage is a quick way to release the muscles surrounding painful joints, says A. Lee Osterman, MD, professor of hand and orthopedic surgery at Thomas Jefferson University and President of the Philadelphia Hand Center. Take the time to learn some simple self-massage techniques that you can do at home, like these tutorials for massaging arthritic joints such as your knees, hands and feet, jaw, and neck. You can also talk to a physical therapist who specializes in arthritis to show you some techniques that will target the specific joints that are causing you pain.
6. Wrap your hands in compression gloves
Wearing compression gloves helps you deal with the cold in two ways: 1) The gloves help keep your hands warm while 2) the compression provides gentle pain relief on your tender joints. Elizabeth P., 35, swears by compression gloves to deal with her rheumatoid arthritis. She even sleeps in them, saying the pressure and added warmth keep her hands more limber and less painful come morning. If you don’t like sleeping in gloves, you can always keep them nearby and put them on when you wake up and before you get out of bed.
7. Talk to your doctor about adjusting your medication
“My psoriatic arthritis is at its all-time worst right now and I think it’s because we’ve been having negative temps with the windchill factor,” says Heather S., 29. In the past she says she’s managed her pain with short-acting medications that she took only during flares but recently her doctor switched her to an injectable biologic treatment that stays in her system much longer. “It’s only been a couple of weeks but I already feel a difference,” she says. “I couldn’t lift my baby before and now I can. I wish I’d switched sooner.”
8. Bring the heat with chili peppers
One way to combat cold-induced pain is with some spicy heat in the form of capsaicin, the active ingredient in chili peppers. “Rub a capsaicin lotion or gel over painful joints to help ease the pain and reduce swelling,” says Don R. Martin, MD, a rheumatologist with Sentara RMH Rheumatology in Harrisonburg, Virginia. “You may feel a slight burning sensation but that should subside within a minute or two.” A meta-analysis published in the journal Systematic Reviews found scientific evidence dating back decades showing that capsaicin has pain-relieving properties for both osteoarthritis and rheumatoid arthritis.
9. Buy a really good snowsuit
Think puffy snowsuits are just for kids? Turns out they are ideal for arthritis patients as well, Amy S. says. “I have a down coat that I bought from Land’s End that has a hood and goes almost to my ankles, as well as fleece-lined snow pants, and I wear them any time I’m going to be outdoors in the cold for more than a few minutes,” she says. “Do I look ridiculous loading my groceries into my car? Probably. Do I care? Nope. Sometimes I even wear them in my house. Keeping my joints warm is everything.”
10. Sip a mug of golden milk
Nothing feels as good as a hot drink on a cold day and “golden milk” isn’t just comforting; the turmeric spice that gives the beverage its characteristic “golden” color has been shown to reduce arthritis pain, Dr. Martin says. Turmeric is a powerful anti-inflammatory. You can take it as a supplement but on chilly days, make it into “golden milk,” a traditional hot Indian drink made from any type of milk, turmeric, ginger, cinnamon, pepper, and a dash of maple syrup. Turmeric showed measurable improvements in arthritis symptoms in a meta-analysis published in the journal Frontiers in Nutrition.
11. Do a home paraffin wax treatment
You may have seen these strange-looking treatments at nail salons and spas but they benefit more than just beauty. Paraffin is a type of wax that melts at a relatively low temperature, which allows you to dip your hands, forearms, feet, and lower legs into it without being burned. This may sound a little strange but it can really help reduce pain and swelling from arthritis, Dr. Osterman says. The wax coats your skin and as it dries it holds the heat in longer than a traditional foot soak or warm compress (although those can be very helpful forms of heat therapy for arthritis as well). “Anything that uses heat can help reduce stiffness and pain,” he says. Plus you could end up with softer, smoother skin.
12. Make yourself a ‘hot pocket’ in bed
Cold definitely increases pain and stiffness for Angela K., 50, who has rheumatoid and osteoarthritis. One of her favorite tricks is to sleep with two heated blankets — one on top, one on bottom, forming a heated cocoon she can lie in. “On cold mornings, I’ll often just soak in the warmth for a good 15 minutes before getting up,” she says.
13. Wear supportive splints
On cold days when your joints are flaring wearing a resting splint can help relieve inflammation and give you some pain relief, Dr. Osterman says. These devices, usually made of plastic and secured with velcro, work by temporarily immobilizing the joint and allowing it time to rest, he explains. You can find splints designed to fit any joint in your body, including ring splints for finger pain and hip belts for hip and sacroiliac joint pain.
14. Break out your yoga mat
One of the reasons that your pain may seem worse when it’s cold is because people are less inclined to move or go outside when it’s chilly, says Anca Askanase, MD, a rheumatologist and director of rheumatology clinical trials at Columbia University Medical Center. Doing some light exercise, like yoga, Pilates, tai chi, or Qigong, or taking a short walk will not only help warm your body up on cold days but will help your joint pain as well, she explains. “One of the best things you can do is to keep moving, even when you’re in pain,” Dr. Askanase says.
15. Soak up the heat in a sauna or hot tub
There’s a reason heat is often the first thing recommended for joint pain — it really helps, Dr. Askanase says. Heat and moisture together often work better to reduce arthritis pain than either on its own so take advantage of this by spending some time in a hot sauna or steam room (check your local community center or gym). If you prefer to stay at home, a hot bath often does the trick, she says. Keep all the doors closed and the fan off so the steam can build up in your bathroom.
Not Sure What’s Causing Your Pain?
Check out PainSpot, our pain locator tool. Answer a few simple questions about what hurts and discover possible conditions that could be causing it. Start your PainSpot quiz.
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Do your joints ache when rain is in the forecast?
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People whose arthritis seems to flare before or after it rains wonder if damp weather is making their arthritis worse. Rheumatologists say they get this question a lot, even though not much evidence supports a link between sore joints and damp weather.
Elaine Husni, MD, a rheumatologist at Cleveland Clinic’s Orthopaedic & Rheumatologic Institute, considers why arthritis pain goes up when the rain comes down. “Some people believe that when you drop the barometric pressure, your air pressure, that sometimes your tissues can swell.” Dr. Husni says. “When your tissues swell in an already inflamed joint, sometimes that can push against muscles and nerves in the area and make it appear more painful,” she adds.
Dr. Husni says that weather does not cause arthritis or make it worse. She says it just may alter the symptoms a bit for that day.
Many of her patients tell her cooler, damp weather is worst, so Dr. Husni says to pay close attention to the weather report and anticipate what’s coming. She says if you know that damp weather bothers you, then you can make some arrangements for that day.
“You might want to bring some extra sweaters or gloves, something that will kind of shield you from the cold and the dampness,” she says. Dr. Husni notices that many of her patients tell her warm weather actually makes their joints feel better, so summer offers them some relief.