Rheumatoid Arthritis: More Common in Colder Climates?

You feel tired and your joints ache, but the symptoms seem to come and go—and of course they're never present when you visit the doctor. If this sounds like you, could be you're suffering from rheumatoid arthritis, an autoimmune disease characterized by inflammation of joints and bone tissue that doesn't seem to have any known causes or definite risk factors. Even the symptoms can be hard to pin down.

"We simply don't know much about rheumatoid arthritis," says Nortin M. Hadler MD, professor of medicine and microbiology/immunology at the University of North Carolina at Chapel Hill, and attending rheumatologist at UNC Hospitals. "And it's certainly not for lack of trying." As researchers continue to investigate potential causes, they're turning to possible environmental factors that could trigger the onset of the disease. One study, published in a recent issue of the journal Environmental Health Perspectives, suggests that where you live could play a role.

How to manage arthritic joints.

THE DETAILS: The study authors used data from the long-running Nurse's Health Study, which began in 1976 and includes nurses living in all 50 states. Questionnaires provided information about where the nurses lived at the beginning of the study and where they've moved since, and whether they've been diagnosed with rheumatoid arthritis. The study authors gathered this information on 9,681 women.

There were significantly more women who had been diagnosed with rheumatoid arthritis while living in northern states than in southern and western states. The researchers also looked back to the nurses' 1988 addresses to see where women with rheumatoid arthritis had been living before being diagnosed. Those addresses revealed an even higher risk for women in some of the northernmost regions of the country: northern Washington state near the Canadian border; the northernmost portions of Wisconsin and Michigan; northern Vermont, northern New Hampshire, and southern Maine. This suggests that rheumatoid arthritis risk was influenced more by where the nurses lived when they were younger, rather than where they lived when diagnosed, the authors write.

WHAT IT MEANS: While the study shows some pretty compelling data, says Dr. Hadler, it doesn't provide physicians with enough evidence to suggest that women at risk for the disease start moving south. "People have been looking for causes for years and we can't find one," he says. But he adds that geographic locale could influence onset of the disease, for instance, bacteria and viruses that could trigger an autoimmune response. There may be some type of rheumatoid arthritis-related bacteria that thrive up north but languish more the farther south and west you go, suggests Dr. Hadler, who wasn't affiliated with the study. Or, the explanation could be even more basic. "It could just be that nurses are more willing to report and seek treatment for rheumatoid arthritis in colder climates, rather than in warmer climates, where it's easier to cope with," he says.

The concentration of the disease in northern climates also suggests that vitamin D deficiencies, which occur when people don't get exposed to enough sunlight, could be a factor; increasing amounts of research link vitamin D to improved bone and joint health. However, Dr. Hadler says that studies linking vitamin D deficiencies and rheumatoid arthritis have been inconclusive at best. It's also possible that genetics play a role, as a family history of the disease has been shown to increase risk.

Here's some additional information and advice on the disease:

All women are at risk
Dr. Hadler says rheumatoid arthritis used to manifest itself in younger women, but now it's common across a wider range of ages. But, he adds, the disease seems to be milder than it used to be.

Beware of pesticides
A study presented at last year's American College of Rheumatology annual meeting suggested that home insecticides may play a role in the disease. The study of over 75,000 women found that those who sprayed insecticides at least six times per year had almost two and a half times the risk of developing rheumatoid arthritis, compared with those who didn't use any at all. If you have a bug problem at home, try one of these natural insect-control tips rather than using insecticides.

Pay attention to these symptoms
Rheumatoid arthritis can be difficult to diagnose, as many of its symptoms mimic those of other autoimmune diseases, such as lupus and fibromyalgia. However, rheumatologists look for at least four of the following criteria when attempting to diagnose it: morning stiffness in and around the joints lasting at least one hour before improvement; at least three joint areas with simultaneous soft-tissue swelling or fluid; at least one swollen joint in the wrist, knuckle, or middle joint of a finger; simultaneous affliction of the same joint areas on both sides of the body; lumps of tissue under the skin; and bone erosion in the wrist or hand joints, detected by x-ray.

Natural treatments may help
"There's no standard treatment and no cure for rheumatoid arthritis, and we generally design therapy depending on the manifestation of the illness," says Dr. Hadler. That may include medications, joint replacements, or injections into your joints. A recent analysis published in the journal Alternative Therapies in Health and Medicine found that high doses of omega-3 fatty acids, around 18 grams per day, helped alleviate some of the inflammation associated with the disorder. Another study in the same journal found that women who took 75-minute yoga classes three times a week were better able to cope with the depression and psychological angst that sometimes accompanies the disease.

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