Q&A: Why 'Jack Frost' may spoil winter plans for some with autoimmune diseases

Most Coloradans look at winter as a time of excitement when the high country turns into our own winter wonderland with the opportunity to create lifelong memories. But for many who live with autoimmune diseases, the colder months may mean more pain, fatigue and unexpected disease flares that hamper the excitement of the snow and the holiday season.

Below, Laura Kelley, media relations professional in the CU Anschutz Office of Communications, speaks with Kevin Deane, MD, Ph.D., professor of medicine in the Division of Rheumatology at the University of Colorado School of Medicine, about what those with autoimmune diseases could be facing during the next few months and how they might be able to mitigate symptoms.

Patients with autoimmune diseases like rheumatoid arthritis, lupus, and psoriasis tend to see some of their worst flares in the winter months. Why?

Not all patients experience flares—and some even feel better in the cold—but some might. It depends on the type of underlying disease and the type of flare. For example, people with lupus may have Raynaud's, which is when the blood vessels constrict, often related to cold. As such, during colder times, Raynaud's may 'flare.' Also, some think that barometric pressure changes that can occur more in winter/colder weather trigger pain receptors, and that can cause a flare of pain. This may happen in any sort of arthritis.

We also see more infections/viruses during the winter months (the flu, colds, sinus infections, etc.) Does that play a role in flares for those who have autoimmune diseases?

There may be a relationship between infections and flares of autoimmune diseases. For example, a cold or flu can cause the immune system to ramp up to fight the infection, and that may 'accidentally' cause the immune system related to the disease to ramp up, too. If someone winds up stopping their medications for a few days because of the infection, that could also allow the underlying disease to flare.

What about the dryer, colder air we have here in Colorado along with less sunlight during winter?

Cold air may be dry air and that can cause dry skin, which may flare up things like psoriasis or flare skin problems in other autoimmune diseases like lupus that affect the skin.

Some think that lack of sunlight during the colder months could cause lower levels of vitamin D, and that may cause immune system flare-ups. For psoriasis in particular, the ultraviolet (UV) light in sunlight can help reduce skin inflammation (UV light is used to treat some forms of psoriasis). So, with less daylight, psoriasis may flare. Lack of sunlight and emotional times around the holidays could also trigger mood issues and when someone is feeling down, other symptoms often feel worse. Sleep may get disrupted with daylight savings time, holiday parties (or alcohol) and generally more stress. That can lead to feeling unwell—even if the autoimmune disease isn't necessarily 'flaring.'

You also mentioned that changes in diet during winter celebrations can have an impact on autoimmune diseases. Talk to me a little about that.

Colder months are associated with holidays—and sometimes holidays are associated with certain dietary intake that could flare some diseases. For example, drinking more alcohol can trigger gout attacks. If someone has Celiac disease (gluten allergy), there may be more treats around with gluten (e.g. cookies) that if eaten can cause a flare of intestinal or other symptoms.

How long do these weather-related flares normally last?

It depends on the type of disease and type of flare but usually not long for things like Raynaud's or aches/pains that flare with barometric pressure changes.

What are the initial signs that indicate a flare might be coming on?

It depends on the type of the disease. If Raynaud's, it can be more aches/pains in fingers and toes and more color changes. In arthritis, it may be more joint pain. If a skin problem like psoriasis, it could be more itching or subtle rash before a big flare-up.

What can those who suffer from these conditions do proactively to prevent flares or at least make them less severe?

Again, it depends on the type of disease. If Raynaud's, keep warm. For other diseases, general rules are to protect yourself from infection through getting up-to-date vaccinations, washing your hands, and avoiding sick contacts when possible. If you get a cold/flu (or COVID) talk to your health care provider and take the right treatments for the infection.

Of note, it may be necessary to stop some immune-related drugs for some time while someone recovers but with your health care provider's guidance, try and minimize the amount of time that someone is off medications. For folks with psoriasis, make sure to moisturize your skin, avoid hot showers because they can irritate/dry the skin; and some people may consider UV light therapy, but they should talk with their health care provider if that is right for them.

What is important for family and friends to know if they have a loved one experiencing a flare during the winter (or any time of the year, really)? What can they do to help?

Offer support. Consider getting vaccines themselves because data suggests people who are vaccinated spread illness less. And if they are sick, avoid contact.