Effect of temperature and humidity on daily pain score in a patient with rheumatoid arthritis

Abstract

Among the complications of this medical therapy, the authors include 5 episodes of infection associated with open lung biopsy, leptomeningeal biopsy, bowel resection necessitated by mesenteric infarction, and antibiotic therapy-related Clostridium dificile enterocolitis. It is not possible to determine in such complex cases whether these infections might also have occurred in the absence of any immunosuppressive medications.We remain concerned about any infectious complications of cyclophosphamide and glucocorticosteroid therapy. However, we believe that Bradley et al have observed an unusually high incidence of such problems because they did not adhere to our guidelines for reduction of glucocorticosteroid therapy, and they included 5 sequential complications of intestinal infarction and surgery in 1 patient. Reply To the Editor:Hoffman et a1 correctly identified several important features of our series of patients: 1) many infections occurred as complications of the underlying vasculitis (e.g., bowel infarction) or of procedures performed (e.g., placement of an indwelling catheter, thoracotomy); 2) the mode of corticosteroid therapy (every other day versus daily) appeared to be related to the incidence of infection; and 3) the duration of corticosteroid therapy, and particularly, daily corticosteriod therapy, was longer than that previously recommended (Cupps TR, Fauci AS: The Vasculitides. Philadelphia, WB Saunders, 1981).While we could not determine a causal relationship with infection for either corticosteroid or cyclophosphamide therapy, in 6 of 10 patients in our series who became infected, infection occurred within 4 weeks of the initiation of cyclophosphamide therapy. Only 2 of 10 developed an infection within the first month of corticosteroid therapy.While the average daily corticosteroid dosage at the onset of the first infection was >40 mg, it was consistent with the guidelines promulgated by Cupps and Fauci for the administration of concomitant corticosteroids during the first month of cyclophosphamide therapy. As stated in our report, infection did not correlate with the dosage or duration of corticosteroid therapy, but seemed more closely associated with the initiation of cyclophosphamide therapy. We agree with Hoffman et al that in the complicated cases we reported, it is difficult to determine the cause(s) of the infections observed. Our report explored a number of probable factors in addition to those mentioned herein. It would be as much an oversimplification to attribute these infections entirely to the corticosteroid component as it would be to single out the cyclophosphamide component of the therapeutic regimen.

Weather, beliefs about weather, and disease severity among patients with fibromyalgia

“…Contemporary research has not clarified the issue of the effects of weather variables on pain and rheumatic disease symptoms because of similar methodologic limitations, such as small, select samples [3], high attrition rates [4], and single-subject designs [6,7]. Not surprisingly, the literature since Latman's review is characterized by contradictory results.…”

“…Symptoms included 1) stiffness in joints, 2) muscle aches and soreness, 3) tension or migraine headaches, 4) poor circulation or numbness, 5) muscle weakness/low energy, 6) faintness or dizziness, 7) pains in chest, 8) nausea or upset stomach, 9) hot or cold spells, 10) trouble sleeping, 11) poor appetite, 12) feeling down or blue, 13) feeling anxious or tense, 14) trouble breathing, and 15) feeling angry or short-tempered. The impact of weather on symptoms is rated on a 5-point scale.…”

Weather changes and pain in rheumatology patients

“…Despite this, there is paucity of scientific data examining this relationship. Some conditions such as rheumatoid arthritis, osteoarthritis and fibromyalgia appear to be especially sensitive to weather changes 2–5 . Investigations studying the relationship with meteorological changes and pain have been conflicting 6–9 .…”

On the belief that arthritis pain is related to the weather.

“…Some investigators argue that only a simultaneous change in pressure and humidity influences arthritis pain (24), but others find no such pattern (25). Several studies report that weather effects are immediate (20), whereas others suggest a lag of several days (26). Due to the lack of clear evidence, medical textbooks-which once devoted chapters to the relation of weather and rheumatic disease-now devote less than a page to the topic (27,28 (36).…”