Seasonal change and flares

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If you have any type of autoimmune inflammation,  you’ve probably lived through a flare. A flare is a period of increased disease activity or worsening symptoms – a time when the medications you normally rely on to control your disease don’t seem to work.

Well, it is actually true - the change in seasons does affect our health. There is seasonal immune modulation of autoimmune disease.

Consider what happens as the weather gets colder: we tend to be inside more which means we are probably more sedentary. Our diet may change. Both of these will change our microbiome which will have an effect on our health. We may be physically cold at times. Our sleep pattern changes. Indeed, our melatonin pattern changes.

Our vitamin D levels will fall due to less sunshine on our skin and the change in our microbiome. Vitamin D is anti-inflammatory and has been shown to be low often in those with autoimmunity. Our vitamin D level reaches a low point in winter and early spring and is correlated with increased disease activity.

Air pollution can also affect our levels of vitamin D. A spread of pollution in the air has been shown to cause a sharp decline in our vitamin D production.

Similarly, melatonin levels are lowest in spring. Melatonin secretion is affected by night length and exposure to ultraviolet radiation. Immunomodulatory action of melatonin ameliorates the severity of inflammation.

There are more viruses about. Flu season starts and other respiratory viruses. We are more prone to infections and when we do get one, it can take longer for us to recover. Viral infections have been linked to autoimmune onset and flares. They stimulate pro-inflammatory cytokine release and can cause flares by human antigen mimicry as well.

Some of us may also suffer from Seasonal Affective Disorder (SAD) when we become depressed with lack of sunshine. This too may precipitate a flare with less activity, poor sleep, change in diet.

In short, studies have shown that auto antibodies have seasonal fluctuations and are higher in the winter-early spring months. Some view that this is initiated by viral infections enabled by the environmental and lifestyle factors.

Summer isn’t necessarily home free either. Too much exercise can also precipitate flares. Lack of sleep too. And some folks with autoimmune conditions such as Lupus, are sensitive to the sun and are heat intolerant. Ultraviolet radiation, highest in the middle of the day in the summer, can induce cellular apoptosis (death), inflammation and tissue damage which can lead to a flare in some auto-immune conditions.

What shall we do? We have no control over the seasons, apart from moving to another climate!

First off, keep a flare diary so you can see if you have a pattern to your flares.

Have a “flare rescue” plan. This may involve temporary changes to your medication routine. Discuss this with your physician. You do want to settle your flare and not let it drag on. You want to settle it quickly to avoid joint damage and other long term consequences of chronic inflammation.

What can we do in the colder months?

  • Dress appropriately. This may include dressing in layers to trap air and make donning and offing easy.
  • Get outside early in the day to expose yourself to natural light. Exposure will help reset your circadian rhythm and preserve your melatonin cycle.
  • Stay warm. Use heating pads if you are getting cool while sitting.
  • Stay active. Do something that is safe but keep moving and wear appropriate footwear.
  • Warm up your body slowly before exercising - stretch
  • Continue to eat an anti-inflammatory diet
  • Consider vitamin D supplementation. Check your levels and discuss with your health care team.
  • Get your annual flu shot and keep your immunizations up to date.
  • Continue with your health plan: control stress, guard your sleep, eat well, continue with your medications, maintain social contacts, have fun!

What can we do in the warmer months?

  • Watch your exposure to ultraviolet radiation: some is good, too much isn’t. Avoid mid-day sun when UV rays are strongest.
  • Protect your skin and your eyes! Wear UV blocking sunglasses or have specially treated lenses.
  • If you find you are photosensitive, wear light weight long sleeves and a wide-brimmed hat.
  • keep hydrated
  • keep active but do it safely and don’t over-exert nor put undue stress on your joints. Be mindful of your limitations.
  • protect yourself from infectious agents: mosquitoes, ticks
  • continue with your anti-inflammatory diet
  • guard your sleep. This may be more difficult when it remains light longer. Find ways to keep to your sleep schedule (light blocking eye patch)
  • Continue with your health plan: control stress, guard your sleep, eat well, continue with your medications, have social contacts, have fun!

And currently, through the pandemic of CoVid-19, get vaccinated. Arrange to get your 3rd booster if it is available to you. Check your arthritis association website and/or with your rheumatology specialist about withholding your immune modulating medications for a period after your vaccination and/or the timing of your vaccination.

And, remain vigilant. We are not out of this pandemic yet although in parts of countries the hope is rising as numbers are falling. Remember that the delta variant is the most prevalent and is easily transmitted. It is airborne. It can remain in room air for some time if there is not good ventilation. Follow public health guidelines yet: wash your hands well and frequently, avoid touching your face, wear your mask indoors when not in your home,  and keep your distance.

Be mindful.

In health,
Dr Charmaine see Patient Advisory Bio