Managing Sacroiliac Joint Pain During Cold Weather: A Patient's Guide

The cold wave has caused a recurrence of pain in the sacroiliac joint?

Hello Dr.
Tseng, I am a patient with ankylosing spondylitis (21 years old), and I have been experiencing symptoms for 3.5 years.
Currently, under the treatment of a rheumatologist, I have achieved good control over the pain in my sacroiliac joints.
However, since two years after the onset of my condition, I have noticed that during the winter, the pain in my sacroiliac joints tends to flare up easily due to cold fronts.
I would like to ask Dr.
Tseng:
1) I have observed that my sacroiliac joint pain does not respond well to either Meloxicam or Celecoxib.
Whenever a cold front arrives, the pain returns, and it takes more than two weeks of medication for the pain to subside.
I am beginning to wonder whether taking medication is beneficial or if it is better to let it resolve naturally.
Given that I experience pain only during those few instances when a cold front arrives and that Meloxicam or Celecoxib are not effective, is there another stronger pain relief option I could consider? (Since I only take it during cold fronts, it should be manageable.)
2) I believe I am experiencing residual effects from my sacroiliac joint pain (pain triggered by cold weather).
Assuming my condition remains well-controlled in the future, what can I do to potentially reverse the residual effects on my sacroiliac joints? Thank you, doctor.

Hao Xing, 20~29 year old female. Ask Date: 2023/12/06

Dr. Zeng Guosen reply Internal Medicine

Some online users have noted that patients with rheumatic and autoimmune diseases may experience joint pain during changes in weather.
It is recommended to seek medical evaluation to assess the condition of the disease.
Physicians will provide treatment recommendations or adjustments based on the patient's condition.
Do not self-medicate.
If the condition is currently well-controlled, it remains to be seen whether cold weather will still cause pain in the future; this will need to be monitored, as it cannot be determined based on data alone.
Thank you for your question.

Reply Date: 2023/12/06

More Info

Managing sacroiliac joint pain, especially during cold weather, can be challenging for patients with ankylosing spondylitis (AS). Your experience of increased pain during cold weather is not uncommon among individuals with inflammatory conditions, as cold and damp conditions can exacerbate symptoms. Here’s a comprehensive guide to managing your sacroiliac joint pain during such times.

Understanding Your Pain
1. Cold Weather Effects: Cold weather can lead to muscle stiffness and increased sensitivity in joints, which may explain the exacerbation of your sacroiliac joint pain. Inflammatory conditions like ankylosing spondylitis can also be influenced by weather changes, leading to flare-ups.

2. Medication Efficacy: You mentioned that medications like NSAIDs (e.g., meloxicam) and biologics (e.g., secukinumab) do not seem to provide immediate relief during cold spells. This can be frustrating, and it’s essential to understand that while these medications help manage inflammation over time, they may not always provide quick relief during acute flare-ups.

Pain Management Strategies
1. Alternative Pain Relief Options: If traditional NSAIDs are not effective during cold weather, you might consider discussing with your rheumatologist the possibility of using stronger analgesics for short-term use during flare-ups. Options may include:
- Corticosteroids: These can provide rapid relief from inflammation but should be used cautiously and typically for short durations.

- Muscle Relaxants: If muscle spasms accompany your pain, these may help alleviate discomfort.

- Topical Analgesics: Creams containing capsaicin or menthol can provide localized relief.

2. Physical Therapy: Engaging in physical therapy can help strengthen the muscles around the sacroiliac joint, improving stability and reducing pain. A physical therapist can also teach you specific exercises to perform during colder months to maintain flexibility and strength.

3. Heat Therapy: Applying heat to the affected area can help alleviate pain and stiffness. Consider using heating pads, warm baths, or hot packs, especially before engaging in activities that may trigger pain.

4. Lifestyle Adjustments:
- Stay Active: Regular low-impact exercises, such as swimming or cycling, can help maintain joint function and reduce stiffness.
- Dress Warmly: Ensure you are adequately dressed for cold weather, as keeping your body warm can help minimize pain.

- Diet and Supplements: Some patients find relief through anti-inflammatory diets or supplements like omega-3 fatty acids. Discuss with your healthcare provider before starting any new supplements.

Long-term Management and Reversing Symptoms
1. Monitoring and Adjusting Treatment: Regular follow-ups with your rheumatologist are crucial. If you notice a pattern of pain during cold weather, your doctor may adjust your treatment plan accordingly.

2. Exercise and Rehabilitation: Continuing a consistent exercise regimen can help prevent the progression of symptoms. Focus on exercises that promote spinal mobility and core strength, which can support the sacroiliac joint.

3. Mind-Body Techniques: Consider incorporating stress-reduction techniques such as yoga, meditation, or tai chi. These practices can improve your overall well-being and may help manage pain perception.

4. Education and Support: Joining support groups for individuals with ankylosing spondylitis can provide emotional support and practical tips from others who understand your experience.

Conclusion
While managing sacroiliac joint pain during cold weather can be challenging, a combination of medication, physical therapy, lifestyle adjustments, and supportive therapies can significantly improve your quality of life. Always consult with your healthcare provider before making any changes to your treatment plan, especially when considering stronger medications for acute pain relief. By staying proactive and informed, you can better manage your symptoms and maintain a fulfilling lifestyle.

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