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BMC Musculoskelet Disord. 2019 Jan 18;20(1):30. doi: 10.1186/s12891-019-2418-2.

Influence of seasonal changes on disease activity and distribution of affected joints in rheumatoid arthritis.

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Department of Rheumatology, Tokyo Medical University Hospital, 6-7-1 Nishi-Shinjuku, Shinjuku, Tokyo, 160-0023, Japan.
Department of Rheumatology, Tokyo Medical University Hospital, 6-7-1 Nishi-Shinjuku, Shinjuku, Tokyo, 160-0023, Japan.
Rheumatic Disease Center, Kurashiki Medical Center, 250 Bakuro, Kurashiki, Okayama, 710-8522, Japan.
Department of Rheumatic Diseases, Tokyo Metropolitan Tama Medical Center, 2-28-29 Musashidai, Fuchu, Tokyo, 183-8524, Japan.
Department of Rheumatology, Clinical Research Center for Allergy and Rheumatology, National Hospital Organization Sagamihara Hospital, 18-1 Sakuradai, Minami, Sagamihara, Kanagawa, 252-0392, Japan.
Department of Rheumatology, National Hospital Organization Tokyo Hospital, 3-1-1 Takeoka, Kiyose, Tokyo, 204-8585, Japan.



Previous studies suggest that RA activity is sensitive to seasonal changes. This study explored the influence of season on RA activity, particularly the distribution of affected joints, using a nationwide database in Japan.


We investigated 12,839 patients whose RA activity was recorded in spring (n = 3250), summer (n = 916), fall (n = 1021), and winter (n = 7652). Disease activity score (DAS) 28-CRP, simplified disease activity index (SDAI), and clinical disease activity index (CDAI) were used as indices of disease activity. Disease activity was also assessed according to DAS28-CRP scores (remission, low, moderate, or high). The affected joint distribution was investigated using novel joint indices (x, y, z), where x and y are indices for the upper and lower joints, respectively, and z is the index for large joint predominance.


Mean DAS28-CRP and median SDAI and CDAI scores were highest in spring and lowest in fall. There was a significant difference in the DAS28-CRP for fall versus spring and winter. Fall was associated with a higher remission rate, and spring and winter with high and moderate RA activity, respectively. Significant differences in x, y, SDAI, and CDAI scores were found for spring versus summer, fall, and winter, in addition to fall versus winter (except in y). There was no seasonal difference in the z index.


RA activity in the upper and lower extremities may be highest in spring, followed by winter. Seasonal changes should be considered in patients with RA to better understand their symptoms.


Disease activity; Epidemiology; Rheumatoid arthritis; Seasonality

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