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Why Does Cold Weather Affect Arthritis?

Dr. Arnan Sisson, PT/ December 23, 2022

Does Cold Weather Affect Arthritis?

It's not just an old wives' tale. Cold weather does affect arthritis. Every winter we have patients complain of increased arthritis pain, especially in their knees.

Why Does Cold Weather Affect Knee Arthritis?

As the weather's getting colder out a lot of people who have knee arthritis start to complain of increased aches and pains.

It's no wonder that Florida, Arizona, and other warm areas are prime destinations for "snowbirds".

But there's one really important thing that you should know:

Knee arthritis doesn't have to hurt even during cold weather.

To understand why that is, you should understand WHY knee arthritis hurts worse in cold weather, so that you understand what factors you can control, even if you can't move to a warmer climate.

What Factors Affect Knee Arthritis Pain?

Knee arthritis pain is affected by more than just the loss of cartilage in the joint surfaces itself.

In fact, knee arthritis itself doesn't hurt.

It's the inflammatory chemicals produced by two joint surfaces that actually triggers a painful response.

But even more there's more than just inflammation that affects knee arthritis pain.

Researchers have identified different phenotypes of osteoarthritis.

Essentially that means that not all arthritis is the same.

We're not just talking about rheumatoid arthritis vs. osteoarthritis.

There are different types of osteoarthtis. 

In fact, a 2016 systematic review identified 6 different phenotypes of osteoarthritis:

  1. chronic pain phenotype with central sensitization
  2. inflammatory phenotype
  3. metabolic syndrome phenotype
  4. bone and cartilage metabolism phenotype
  5. mechanical (malalignment) phenotype
  6. minimal joint disease phenotype

What does that mean in plain English?

It's easier to explain visually than in words, so I'll show you this Venn diagram that I adapted from a 2014 article on knee arthritis pheontypes.

3 Factors Affecting Knee Arthritis Pain

As the diagram above shows, the pain you experience from knee arthritis is made up of 3 different components:

  1. Structural (anatomical) factors such as the severity of your arthritis on x-rays, the amount of inflammation, and your joint alignment.
  2. Functional (physiological) factors such as the sensitivity of your nerves, your blood sugar, how well you sleep, and how well your body's internal pain control systems work (endorphins / endocannabinoids)
  3. Psychological factors such as your beliefs about pain, anxiety or depression, or a tendency towards catastrophizing (thinking the worse-case scenario will happen)

The 6 phenotypes listed above are basically blends of different amounts of these factors:

  1. chronic pain phenotype with central sensitization - functional and psychological factors drive the pain more than structural factors
  2. inflammatory phenotype - more chemical inflammation mediated (structural)
  3. metabolic syndrome phenotype - obesity (structural) and diabetes (functional)
  4. bone and cartilage metabolism phenotype - functional
  5. mechanical (malalignment) phenotype - structural
  6. minimal joint disease phenotype - minimal structural changes in the joint.  Mediated either by physiological factors, or it's knee pain that's coming from other structures besides the joint (i.e. muscle pain or trigger points)

Not surprisingly, highly mechanical types of knee arthritis tend to respond well to mechanical treatments such as anti-inflammatories or knee replacement.

But by the same token, non-mechanical types of knee arthritis pains don't respond as well to these treatments.

In fact, anxiety and depression are the leading factors predicting persistent pain 1 and 5 years following knee replacement.

Furthermore, a belief that your pain will go away after a knee replacement is a good predictive factor of success.

In other words, there's somewhat of a placebo effect when it comes to knee replacement surgery. 

Now, that's not to say that knee replacement surgery is all placebo.... It works very well for people with high grades of arthritis and lower amounts of physiological and psychological factors affecting their pain.

But placebo works about 30% of the time, so it shouldn't be overlooked.

In other words, if you give people a sugar pill and tell them it's a medicine that will help, 30% of people are likely to improve. 

Now speaking of sugar pills, there are "knee gummies"  that can actually be helpful for some types of knee arthritis beyond just placebo.

Joint Restore Gummies have boswellia (frankincense) and CBD, which both affect different components of arthritis pain.

Boswellia can help control chemical inflammation while CBD affects the endocannabinoid system, which can help lower anxiety and improve sleep.

Put together, they can affect a few different components of arthritis pain and help some people with knee arthritis.

Back to the original question though...

How Does Cold Weather Affect Arthritis?

Cognitively, most people know that cold weather doesn't cause your joints to degenerate more.

You can't get arthritis from cold weather, but could weather can make arthritis pain worse.

Since cold weather doesn't affect the anatomy or structure of your joint, the reasons why cold weather makes arthritis pain worse have mostly to do with your nerve sensitivity.

You have receptors in your joints that respond to all different types of things: temperature, pressures, tissue stretch, chemicals, etc.

What you DON'T have are pain receptors per se.

Your receptors pick up on changes in your environment, and then it's your brain's job to determine if those changes warrant a danger response.

Such a danger response includes things like: 

  • Increased heart rate
  • Increased muscle tension, and
  • Pain (an unpleasant sensation telling you to take action)

Arthritis Pain From Cold Weather Is Evolutionary

Back when we didn't have warm, heated houses to live in, a change in environmental conditions such as a storm or a cold front could be a threat.

So it was beneficial at that time to have a signal telling you to seek shelter or build a fire in order to stay safe.

Very much like birds know to fly south for the winter, humans still have some of those response systems triggering us to changes in the environment, even though they're not quite as relevant in modern times.

Therefore, to stop arthritis pain from cold weather, you need to address the physiological stimulus that's causing the pain response.

5 Ways To Relieve Arthritis Pain From Cold Weather

  1. Stay Warm

This is the number one thing to help arthritis pain from cold weather.  If the cold is the physiological stimulus, then changing the stimulus (cold) can change the response (pain).

Turn up the heat a few degrees, drink a warm beverage, or snuggle up under an electric blanket.

It also helps to dress in layers.  Put on long underwear or wear a knee sleeve to help insulate your knee if you have knee arthritis pain.  There are even knee sleeves that have a heating element to keep your knees warm during cold weather.

  1. Stay Active

It's common to move less when during cold weather. We tend not to go outside and walk or even avoid going places during colder weather.

That means you're moving less. Physical activity and exercise are one of the best treatments for arthritis though.

When you move your joints, they release  synovial fluid.  Synovial fluid is a lubricating fluid that keeps your joints moving smoothly.

When you start to lose cartilage, you produce less synovial fluid as it is, so it's important to utilize what you have.

Another of exercising include that it increases the blood flow to your muscles and joints.  This brings oxygen that your tissues need to produce energy.  It also supplies the raw materials that your joints need to repair themselves.

Additionally, blood coming from your heart is warm, so it increases the temperature in your muscles and joints.

Finally, aerobic exercises such as walking or riding an exercise bike release endorphin hormones into your body that are strong pain controllers.

Endorphins are opioid-like chemical that your brain can produce that are chemically similar to morphine (endo = within, -orphin = similar to morphine). The good news is, that they're about 60 times stronger than man-made versions, and they don't have the negative side effects.

  1. Eat Healthy

Foods high in saturated fats and sugar can increase inflammation in your body. Conversely, anti-oxidant rich foods like fruits and vegetables fight inflammation.  Finally, omega-3 fatty acids are also anti-oxidants that are good for your joints.

Foods high in omege-3 fatty acids include:

  • fish (especially salmon, mackerel, and sardines)
  • nuts and seeds (flax seeds, chia seeds, or walnuts)
  1. Quality Sleep

Sleep is the time when your body repairs itself physically, as well as when you refresh mentally.  Lack of sleep can lead to increased stress and anxiety as well as increased pain sensitivity. Therefore, it's helpful to follow good sleep hygiene tips such as:

  1. Keep your bedroom dark
  2. Have a regular sleeping and waking time
  3. Establish a wind-down routine one hour before bedtime
  4. Avoid electronic devices at night time
  5. Limit caffeine, especially after noon.
  6. Get 20 minutes or more of pre-noon sunlight.

Sleep hygiene is a topic of it's own as to why all of these things help you sleep better. Essentially though, they prime your nervous system for sleep so that you can heal physically and mentally.

  1. Supplement As Needed

Overall, lifestyle factors like the first four items on this list will likely make the biggest impact.  If you don't do those things then suppelments probably won't help your arthritis in and of themselves.

However, if you have those in play, supplements can be a nice... well, supplement, to those other tips.

I already previously mentioned the Joint Restore Knee Gummies above.

Essentially the combination of the boswellia along with the CBD helps target all 3 domains of knee arthritis pain: structural (inflammation), functional (sleep), and psychosocial (anxiety).

Additionally, if you don't get enough anti-oxidants from your diet, supplementing Vitamins A, C, E, and omega-3s can be helpful.

Additionally, a vitamin D supplement can be helpful, especially for people with rheumatoid arthritis.

Normally, your body can produce enough vitamin D from sunlight hitting exposed skin for 10-30 minutes per day.

However, during winter, there's less direct sunlight and we tend to go outside less due to the cold weather.  When we do go outside, our skin is usually covered up so we produce less vitamin D.

It's common for people with rheumatoid arthritis to be vitamin D deficient as it is, but even worse so in the winter.

Additionally, seasonal affective disorder is often linked to a vitamin D deficiency.  Seasonal affective disorder is a seasonal depression that comes on in fall and/or winter and goes away in spring.

As previously mentioned, depression can also affect arthritis pain, so taking vitamin D may be helpful for people who have seasonal affective disorder and arthritis.


Hopefully you found this post helpful better understanding how cold weather affects arthritis pain.

If you need more help for arthritis pain, tap the button below to request an appointment with one of our specialists.

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