One of the most often asked questions that comes our way at Molly’s Fund Fighting Lupus is, “Where is the best place to live with lupus?” Putting it mildly, that question is about as complicated as the disease itself. Now, before I lose you – let me delve into why. The heterogeneity of the disease is such that every single person with lupus is a little different, so inevitably the needs from person to person are different as well. For instance, do you have arthritis or Raynaud’s Syndrome? Are the cold winter months terribly difficult on your hands and feet? Maybe you would feel better in a warm, dry environment. Do you suffer from pleurisy and are sensitive to air quality? Possibly moving away from known populated cities with poor air quality may be wise.
This blog is not intended to provide you with the perfect pinpoint location, or to give you anxiety about where you are currently living. What it is intended to do is provide you with options. To breakdown some of the biggest concerns with people living with lupus and address those concerns. Prioritizing what is most important, i.e., relationship with you doctor, close proximity to friends and family, welcoming neighborhood- also play into your decision. We hope you find this helpful if you are deciding to relocate or are concerned that your environment may be exacerbating your symptoms.
COLD VERSUS WARM
Though the cold versus warm debate may be viewed as anecdotal by some scientists, doctors feel that their patients are convinced that the weather affects their symptoms. In a recent article, Dr. James Fant, Associate Professor of Medicine and Director of Rheumatology at South Carolina’s School of Medicine’s University Specialty Clinics, states how he believes there must be a connection even if they cannot scientifically explain the exact mechanism that is causing the shift in symptoms. He states, “…I believe there is a connection simply because I’ve heard too many patients tell me that they are absolutely sure when it’s going to rain because their knees will hurt more. “ He goes on to say, “Raynaud’s causes cold-induced vasospasms (decreased blood supply in the hands) and it can definitely worsen in colder conditions.” However, with arthritis it’s a matter of preference, he remarks, “With the more prevalent arthritis types like osteoarthritis or rheumatoid arthritis, sun exposure, because it provides warmth, can make you feel better. There’s no evidence that it actually changes the condition, but it can affect you symptomatically in a positive way.”
If you are like the 40-70% of those with lupus who experience photosensitivity (a severity of symptoms when exposed to ultraviolet rays), living in a warm, sunny climate may be difficult, if not near, impossible. The sunniest and hottest cities like Las Vegas, Phoenix, Tucson, and San Antonio, may make it difficult to maintain a lifestyle out of the home. The Pacific Northwest might be the right spot for those who yearn for overcast days, free of hard hitting UV rays. However, some individuals with rheumatoid arthritis find that living in areas that are warm (but not humid), may be better on the joints. Cities like Dallas, Oklahoma City, are on the warmer side, but the levels of humidity are lower than other places. The coldest cities like Fairbanks, Alaska and Fargo, North Dakota – however, can be difficult if you have lung issues, Raynaud’s or suffer from nose, mouth or finger ulcers. For an in-depth study on lupus and the effects of climate changes, click here.
BAROMETRIC PRESSURE CHANGES
Barometric pressure or atmospheric pressure, is the force put forth by the atmosphere, sometimes referred to as the “weight of the air.” Shifts in this pressure, interestingly enough, have been known to cause an increase in lupus symptoms. “Suppose you have an inflamed joint that is subject to swelling,” said Dr. Fant. “If the barometric pressure is decreased, then that would allow the inflamed tissue to swell more, simply because there is less atmospheric pressure holding the tissue back. If there are nerves in that tissue, then, those nerves would be stimulated by that swelling and that would translate into pain.” This is also helpful for those who suffer from lupus headaches or secondary migraines and are sensitive to atmospheric pressure changes. Dr. Daniel Wallace, Clinical Professor of Medicine at Cedars-Sinai Medical Center and Board Certified Rheumatologist states it simply, “ The best climate for people with lupus is one with the fewest changes in the barometer.”
If you are on the hunt for the places that experience the least amount of barometric pressure changes, look no further. Here are the top five cities:
- Honolulu, Hawaii
- Miami, Florida
- San Diego, California
- Los Angeles, California
- Tampa, Florida
Personally speaking, this is a big one for me. My lungs, my lupus, and my life are deeply affected by the air quality. A 2010 study by Environmental Health News found that exposure to fine particles in air was indeed associated with increased lupus activity. In fact, the study noted both increased levels of protein in the urine, as well as, negative changes in antibodies when a patient was tested two days after being exposed to the air pollutants. This adds to the pool of evidence that air pollution (harmful substances including particulates and biological molecules in the air) can have a serious impact on lupus and other autoimmune disorders.
Which cities in the U.S. have the best air quality, you ask? Here are the winners:
- Cheyenne, Wyoming
- Sante Fe, New Mexico
- Bismarck, North Dakota
- Great Falls, Montana
- Honolulu, Hawaii
There is no denying that those with lupus are more likely to experience infection and infection-related complications due to compromised immune systems (from the disease AND medications used to treat the disease). The most common infections for people with lupus include those of the respiratory tract, skin and urinary system. Living in large cities, where taking mass transit systems, crowded elevators and shopping centers daily, leading to the exposure of thousands of people’s germs, can be worrisome.
In a recent article by The National Institutes of Health, Dr. Carl-Johan Neiberud, echoed that concern by stating, “The density of inhabitants and the close contact between people in urban areas are potential hot spots for rapid spread of merging infectious diseases such as severe acute respiratory syndrome (SARS) and the avian flu.” Just to name a few.
How do you remedy this? Well, if it is your desire to stay away from the most populated areas of the U.S. – don’t move to these top trafficked spots:
- New York CIty, New York
- Los Angeles, California
- Houston, Texas
- Philadelphia, Pennsylvania
And while you are at it, stay away from:
- Phoenix, Arizona
- San Antonio, Texas
- San Diego, California
BEST LUPUS HOSPITALS
Now, before you pack up and move to a remote part of the U.S., be cognizant of the fact that you will need to be somewhat close to a lupus doctor. And if you are wanting to see the best doctors at the best hospitals, here are the top hospitals for rheumatology:
- Johns Hopkins Hospital, Baltimore Maryland
- Cleveland Clinic, Ohio
- Hospital for Special Surgery, New York-Presbyterian University Hospital of Columbia and Cornell
- Mayo Clinic, Rochester Minnesota
- Brigham and Women’s Hospital, Boston, Massachusetts
- Hospital for Joint Diseases, NYU Langone Medical Center, New York City
- Massachusetts General Hospital, Boston
- University of California, Los Angeles, Medical Center
- University of Pittsburgh Medical Center, Pennsylvania
- University of California, San Francisco, Medical Center
- University of Alabama at Birmingham
- Duke University Hospital, Durham, North Carolina
- Northwestern Memorial Hospital, Chicago, Illinois
- University of Michigan Hospitals and Health Centers, Ann Arbor
- Stanford Hospital and Clinics, California
If you have been keeping score, you will notice that some potential prospects for good “lupus living locations” might be Honolulu, Hawaii if you like warmer climates with zero barometric pressure changes and good air quality. Baltimore, Maryland if you want to be near the best lupus hospital that also has a small town feel, with mild seasonal changes. Great Falls, Montana and Cheyenne, Wyoming both offer clean air, beautiful scenery and a less populated living. If you are looking to avoid the year-round sun, the Pacific Northwest might be your heart’s desire, and hey, you can stop by the Molly’s Fund Portland Support Group as an added bonus!
At the end of the day, you will be healthiest, where you are happiest. Sometimes it’s not as much about geography as it is about relationships and comfort. It’s up to you to decide where home is, because as my pillow says, “It is where the heart is.”