The signs are familiar: a thickness to the air, dark clouds overhead, a heavenly rumble in the distance, and 58 million Americans may feel a stirring in their bones: a storm is brewing. Stiffness, swelling, ache, pain; among those living with arthritis the symptoms are all too familiar. They fluctuate, wax and wane, ebb and flow, as the rhythms of the earth change with the movement of the clouds, the turning of the seasons. For many with arthritis, the equivalence between patterns of symptoms and sky is not just a matter of consideration or curiosity; rather it is an equivalence of absolute merit.
On a hot, thick afternoon in late June, I interviewed an elderly patient at the Bellevue Hospital primary care clinic. As we made our way through a lengthy problem list, we reached the final item: osteoarthritis, last alphabetically, and, among its neighbors of hypertension, hyperlipidemia, and diabetes, by my medical student estimation, last in priority. The patient attested to frequent pain in her fingers and toes, some days worse than others. Today was a worse day. “The joints are bad right now. It’s going to rain, it’s always worse when it’s going to rain. It’s in my bones.” We ended our visit, but this suggestion stuck with me: could arthritic symptoms really fluctuate with the weather? I tended to think not, but did find myself peeking out windows, surveying for raindrops. I concluded that this was likely a long-held belief without base, passed down from one generation of arthritis patients to another, reinforced by coincidental cooccurrences of stormy weather and flare ups. At the end of the day, as I walked down First Avenue, I laid the question to rest. Then the rain began to fall.
With a new uncertainty coming over my wet head, I sought to investigate the veracity of my patient’s claim. That night I dug through a slew of content concerned with the question of weather and arthritis. My first discovery confirmed that my patient was very much not alone in her convictions. The persistence of the belief that weather and joint pain are connected has been studied and documented. Investigation into this question spans the history of medicine, as Hippocrates is noted to have considered an environmental source of joint pain in his work, On Airs, Waters, and Places. Since that suggestion 2,500 years ago, researchers have investigated the relationship, with studies measuring subjective pain scores, inflammatory markers, and even objective joint stiffness concluding largely in favor of an association between humidity and arthritic symptoms. While the direct clinical utility of this research may be limited, authors did not shy away from offering recommendations. Some advised clinicians to consider informing their patients of the association and to suggest climate-controlled settings on humid days. I considered whether I should have told my patient to review the weather report from time to time; though I expect she will always be one step ahead of the best meteorologist.
During my investigation, I noticed that I had an eye toward disproving rather than proving an association between weather and arthritis. I approached the papers with more than a healthy dose of skepticism. While some were not perfect, and I do not expect to see research on this topic appearing in the New England Journal anytime soon, it became clear that I could not dismiss this research as “pseudoscience,” as I felt inclined to. Why was I so quick to mentally discount the possibility that the patient’s belief about her disease might be true? Perhaps biases were at play. Maybe I assumed that my patient would be vulnerable to anecdotes and had picked up a belief which, I suspected, had no basis in biological reality. Yet, I think the substance of my disbelief was an unwillingness to accept that something as cosmic and protean as the weather could exert a consistent, measurable effect on a tiny proximal interphalangeal joint. I considered this and reflected on the reality: we are not such masters over the environment as our modern comforts might deceive us into believing. Rather we are objects of our environment, subject to the thousand natural shocks that flesh is heir to. In recent decades, the medical establishment has come to recognize this truth. The relationship of our health to our surroundings, both ecological and social, has been codified in several trending terms, the “biopsychosocial framework” and “environmental medicine.” Yet, in many ways, this twenty-first century approach of holistically considering the health of a patient is in no way new. It is a revival of a quite literally ancient perspective.
Hippocrates opens On Airs, Waters, and Places by advising physicians: “Whoever wishes to investigate medicine properly, should proceed thus: in the first place to consider the seasons of the year, and what effects each of them produces for they are not at all alike, but differ much from themselves in regard to their changes.” The experience of investigating my patient’s beliefs about weather and arthritis was a humbling one. For one, it was a reminder that patients are often right and that they tend to know their disease better than any. I learned that the greatest weapon in the arsenal of modern medicine, evidence-based research, sometimes serves only to support that which has been observed for thousands of years. Perhaps most of all, in the ubiquitous presentation of arthritic pain, I found a reminder of a simple, ancient truth: we are the stuff of the earth. Our health, our lives, our humanity are inseparable from the greater world. Our bodies are in constant communion with the sea and the sky, as the currents of the synovial ocean within shift like the tide. The weather, and perhaps, all that which is beyond us, ought not to be viewed as remote but as intimate. The spark that lights the skies is not so distant. It’s in our bones.