Come rain or shine: Is weather a risk factor for musculoskeletal pain? A systematic review with meta-analysis of case-crossover studies

Abstract

Objectives: The weather is frequently blamed for changes in musculoskeletal health behaviour and adverse events. However, despite the frequency with which this phenomenon is endorsed, past research is largely conflicting. This meta-analysis has reviewed, appraised and summarised case-crossover studies assessing the transient risk of musculoskeletal health events associated with weather parameters (e.g. temperature, relative humidity, air pressure, and precipitation).

Methods: A meta-analysis of case-crossover studies was conducted. Two reviewers independently searched MEDLINE, EMBASE, CINAHL, Web of Science, Scopus, and PsycINFO from inception to 10/09/2023. Published studies that employed a case-crossover design to evaluate the risk of musculoskeletal health events (e.g. symptoms, hospitalisation) associated with weather parameters were included. Primary outcome was pain (new episodes of pain or flares). Quality of included studies was assessed based on selection bias, exposure assessment, confounding, and outcome assessment. Pooling of results was conducted using random effects models and separately performed for each condition and weather factor. Heterogeneity among included studies was assessed using I² measures.

Findings: Of the 1,107 studies identified in the search, 11 were included (15,315 participants), providing data on 28,010 events (102,536 control periods), for seven musculoskeletal conditions. Pooled analyses showed no association between relative humidity, air pressure, temperature, or precipitation and the risk of rheumatoid arthritis, knee pain or low back pain. High temperatures combined with low humidity were associated with increased pain, redness, and joint swelling in people with gout (Odds Ratio: 2.04; 95 % Confidence Interval: 1.26 to 3.30).

Interpretation: Despite anecdotal reports from patients, changes in weather factors do not seem to be risk factors for rheumatoid arthritis, knee, hip, or low back pain, but may have a significant influence in gout disease.

Keywords: Case-crossover; Conditional regression; Meta-analysis; Musculoskeletal pain; Weather.