Adult male drinking water after working out.
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As temperatures rise, it’s easy to become very parched (very quickly) and not even realize it. But forgoing water during the heat is dangerous, and becoming dehydrated when you have arthritis can result in added pain and issues. Dehydration causes a host of symptoms, such as sleepiness and dizziness, and increases your risk for heat injury or low blood volume shock. But it can also affect the mechanisms that keep your joints functioning smoothly; it can reduce the fluid that cushions your joints or increase inflammation throughout your body.

“There’s no scientific study at this point or to my knowledge that shows arthritis patients may need more water [than those without arthritis], but ensuring adequate hydration might be more important in terms of joint health,” says clinical rheumatologist Magdalena Cadet, MD, Associate Attending Physician at NYU Langone Health in New York City.

It’s important to look out for yourself and others year-round, but especially in the summer when temperatures are high. Here’s everything to know about dehydration and arthritis, and how to make sure you drink enough water to manage joint pain and stay safe during the summer.

How Dehydration Affects Your Arthritis

When you’re dehydrated, the parts of your body that help keep arthritis aches and pains at bay may not function as well.

Water helps create synovial fluid, a thin layer of fluid that cushions and delivers nutrition to your joints. Synovial fluid also reduces friction when you move your joints, according to a July 2019 study in Nutrients. When you’re dehydrated, your body may struggle to create synovial fluid, which may result in more friction and pain.

“We know that synovial fluid can reduce friction and the rubbing of joints together,” says Dr. Cadet. “And water is important for maintaining tissue health and keeping our joints healthy.”

Water is also crucial for your cartilage, as about 65 to 80 percent of cartilage is made of water, according to an article in the British Medical Bulletin. (That percentage decreases as you age.) Cartilage is a strong and flexible tissue that covers the ends of your bones. Your cartilage allows your bones to glide over each other, which helps you move, and it also protects bones by preventing them from rubbing against each other.

“When we drink water, we not only help stimulate the production of synovial fluid, but also help with cartilage regeneration and lubrication of the cartilage to reduce joint inflammation,” says Dr. Cadet.

It helps to think of cartilage as a sponge: When it has enough water, it’s soft. When it dries out, it becomes stiff and difficult to move.

Hydration also supports the supply of blood to the heart cells and other organs, which is important for people with an underlying health issue that may impact other organs, such as arthritis.

“We know that rheumatoid arthritis and psoriatic arthritis involve other organs, and we know hydration is important for the protection of our heart, our skin, and other organs, so it’s also good to stay hydrated to allow good blood volume to those organs,” says Dr. Cadet. “Hydration also helps your muscles function properly, and we need our muscle function to help with our joint function.”

So, how much water should you be drinking? According to the National Academies of Sciences, Engineering, and Medicine, the adequate intake (AI) of water — which can come from beverages (like water and tea) and food (like fruits and vegetables) — for men ages 19 and older is 3.7 liters (about 16 cups) liters each day, with 3 liters (13 cups) coming from beverages. For women, the AI is 2.7 liters (about 11 cups) of water, with 2.2 liters (9 cups) coming from beverages.

This number, however, may change depending on the season and your activity level. For example, if you’re spending time working outside in the heat, the U.S. Centers for Disease Control and Prevention (CDC) recommends drinking one cup of water (8 ounces) every 15 to 20 minutes.

It’s also recommended that you drink water in short intervals throughout the day rather than drinking a lot of water at once, as the latter may cause discomfort.

Similarly, you don’t want to drink too much water. According to the Mayo Clinic, this can lead to hyponatremia, a rare condition that occurs when the kidneys are unable to get rid of excess water, thus reducing the concentration of sodium in your blood to a dangerously low level. This can cause muscle spasms and cramps, as well as headaches, fatigue, and nausea.

Is Your Joint Pain Related to Dehydration?

If it’s hot and you feel particularly uncomfortable, it’s likely that dehydration is at least partially to blame. Even mild dehydration may have effects on your pain level.

“The synovial fluid and the cartilage tissue cells need water to help reduce friction and maintain motion between the joints,” says Dr. Cadet. “Even small amounts of dehydration or not drinking enough water daily can contribute to joint pain.”

Depending on how dehydrated you are and your specific condition, your symptoms may be mild or severe.

“I don’t know if we can put a time course on it, but obviously the more dehydrated you are [and] the more time that lapses, the more apparent joint pain or other symptoms may be,” says Dr. Cadet. “There are also other more serious conditions, like heat stroke and muscle breakdown, that can occur with severe dehydration.”

Common signs of dehydration, according to the Cleveland Clinic, include:

  • Headache, confusion, or delirium
  • Tiredness/fatigue
  • Dizziness, weakness, and light-headedness
  • Dry mouth and/or a dry cough
  • High heart rate but low blood pressure
  • Loss of appetite
  • Flushed skin, swollen feet, and muscle cramps
  • Heat intolerance or chills
  • Constipation
  • Dark-colored pee (it should be a pale, clear color)

You may see symptoms of dehydration improve five to 10 minutes after drinking water. But if you think your symptoms are severe, or are taking longer to improve, call 911 or go to the emergency room immediately.

Severe symptoms of dehydration may include:

  • A body temperature of 103o Fahrenheit or higher
  • Muscle twitching
  • Red, hot, dry skin
  • Nausea
  • Rapid pulse
  • Seizures
  • Lack of sweating
  • Confusion, altered mental state, slurred speech
  • Dizziness
  • Fainting, loss of consciousness
  • Hallucinations

How to Avoid Dehydration

The best way to avoid dehydration is to drink up before you get thirsty. It’s especially important to monitor your water intake when your region is experiencing a heat wave, says Dr. Cadet.

To see if you’re getting enough water, take a day to track how much water you drink and any symptoms you may experience. Gradually increase the amount of water each day, while continuing to track your symptoms. You’ll know you’re getting the right amount of water when the symptoms subside. You may, however, need more water during times of high temperatures. But having a baseline water intake level can help you adjust as seasons change.

In addition to increasing your water intake, you want to make sure you’re getting enough electrolytes. These are minerals like sodium, calcium, potassium, chloride, phosphate, and magnesium that have an electric charge and help balance the amount of water in your body, according to the U.S. National Library of Medicine. You can get them through fluids like milk, or foods like bananas and watermelon.

Of course, drinking enough water is easier said than done. But there are several simple steps that can help you make hydration a part of your everyday life.

“I always encourage patients to drink water when they get up in the morning, try to drink water with their meals, and to drink water instead of sugary drinks,” says Dr. Cadet. You might even try replacing at least one sugary beverage, like soda, with water every day until drinking plain or fruit-infused water becomes a habit.

And remember, it’s not enough to drink a lot of water occasionally. You need to increase your overall water intake each day to get the long-term benefits of hydration.

“The idea of building hydration as a habit is important, because the more something becomes habitual, the less conscious attention we have to give to it,” says occupational therapist Julie Dorsey, OTD, OTR/L, a Professor of Occupational Therapy at Ithaca College in Ithaca, New York.

Here are Dorsey’s five tips for making hydration a habit.

Set reminders. Use your phone, a smartwatch, or fitness tracker to remind yourself to hydrate at regular intervals throughout the day (say, every hour). “Those are really helpful because they become part of your everyday routine,” says Dorsey. There are even water bottles that help you track your water intake by the hour, such as this Motivational Water Bottle with Time Marker & Hourly Hydration Measurements.

Give yourself visual cues. For a low-tech solution, try putting reminders in places you’ll see them regularly. For instance, put sticky notes that read, “Time to hydrate!” on various doors throughout your house or place filled, reusable water bottles throughout your home, like next to your bed, in your living room, or on your desk.

Set attainable goals for yourself. Hourly goals may feel more manageable than setting a large goal like drinking a certain number of ounces per day, says Dorsey.

Do challenges with other people. Most things are easier to accomplish if you have a partner (or two, or three.) If your family, friends, or coworkers want to reach a similar water intake goal, set up a group that keeps each other accountable and checks in on each other.

Flavor your water. Admittedly, normal water can get boring, which is why Dorsey suggests adding fresh fruit, cucumbers, or mint. “Changing the flavors throughout the day and trying new combos can help you get excited about it,” she says. You can even find water bottles designed to infuse water with fruit, like the Hydracy Fruit Infuser Water Bottle. You may also want to try eating more water-rich foods such as celery, iceberg lettuce, zucchini, and watermelon, per the Cleveland Clinic.

How to Handle Joint Pan in the Heat

You may feel like the heat intensifies your joint inflammation, swelling, and stiffness. If you’re generally uncomfortable from the heat, Dorsey recommends using ice or cold compresses on achy joints, elevating your hands, and moving with light and gentle exercises to avoid stiffness.

Not surprisingly, ice is a favorite way for members of our community to soothe their joints during heat waves. Becca R. says she uses, “ice baths for my hands and feet with Epsom salt and tea tree,” to relieve pain during hot weather.

“The one good thing about having arthritis and being in extreme heat is I already had a ton of ice packs in the freezer and great cooling down skills from always feeling overheated with rheumatoid arthritis,” Eileen D. says.

And if you don’t have a freezer of ice packs, there are plenty of  household items you can turn into ice packs.

Track Your Symptoms with ArthritisPower

Join CreakyJoints’ patient-centered research registry and track symptoms like fatigue and pain. Learn more and sign up here.

Bełdowski P, et al. Hydrogen and Water Bonding between Glycosaminoglycans and Phospholipids in the Synovial Fluid: Molecular Dynamics Study. Materials. June 27, 2019. doi: https://doi.org/10.3390/ma12132060.

Bhosale A, et al. Articular cartilage: structure, injuries and review of management. British Medical Bulletin. August 1, 2008. doi: https://doi.org/10.1093/bmb/ldn025.

Dehydrated? These 7 Foods Will Satisfy Your Thirst and Hunger. Cleveland Clinic. December 30, 2020. https://health.clevelandclinic.org/dehydrated-these-7-foods-will-satisfy-your-thirst-and-hunger/.

Dehydration. Cleveland Clinic. February 16, 2021. https://my.clevelandclinic.org/health/treatments/9013-dehydration.

Fluid and Electrolyte Balance. U.S. National Library of Medicine. Accessed July 4, 2021. https://medlineplus.gov/fluidandelectrolytebalance.html.

Hydration. U.S. Centers for Disease Control and Prevention. Accessed July 4, 2021. https://www.cdc.gov/niosh/mining/UserFiles/works/pdfs/2017-126.pdf.

Hyponatremia. Mayo Clinic. May 23, 2020. https://www.mayoclinic.org/diseases-conditions/hyponatremia/symptoms-causes/syc-20373711.

Interview with Magdalena Cadet, MD, Associate Attending Physician at NYU Langone Health in New York City

Interview with Julie Dorsey, OTD, OTR/L, professor of occupational therapy at Ithaca College in Ithaca, New York

Report Sets Dietary Intake Levels for Water, Salt, and Potassium to Maintain Health and Reduce Chronic Disease Risk. National Academies of Sciences, Engineering, and Medicine. February 11, 2004. https://www.nationalacademies.org/news/2004/02/report-sets-dietary-intake-levels-for-water-salt-and-potassium-to-maintain-health-and-reduce-chronic-disease-risk.