Choosing where to live can be a difficult decision. There are many factors to consider, like home prices, job opportunities, proximity to family and friends — the list goes on. For people living with ankylosing spondylitis (AS), some factors may warrant extra attention. These include health care access and affordability, opportunities to stay active, and the weather — as cold, humidity, or heat sometimes affect symptoms.

In this article, we’ll look at what research has found — and what MySpondylitisTeam members have to say — about the best U.S. states to live in for people with ankylosing spondylitis.

Deciding Factors

Access to affordable health care and to healthy lifestyle activities are important considerations for anyone with AS. The American College of Rheumatology in 2022 released the latest version of its Rheumatic Disease Report Card, which assesses how supportive states are for people with AS and other rheumatic diseases.

Judges rated states on the following categories:

• Access to quality health care and rheumatologists — States with higher scores were those that put limits on insurance companies’ use of step therapy and prior-authorization requirements, practices that make it more difficult for people to get the medication and treatments they need.
• Affordable health care — Here, researchers considered whether states had policies to prevent insurers from using practices that drive up costs, like drug speciality tiers and copay accumulators.
• Activity and lifestyle options — Researchers looked at which states had more activity and lifestyle opportunities for people with rheumatic conditions.

For each category, a state could earn up to 50 points — for a total possible score of 150. States were also assigned letters grades for each category, along with an overall grade.

Highest- and Lowest-Ranking States To Live In With Ankylosing Spondylitis

In 2018, one state managed to earn the coveted A grade from the American College of Rheumatology: Maryland. Maryland is also home to the top-rated hospital in the United States for rheumatology, Johns Hopkins, located in Baltimore.

However, in 2022, no states earned an A grade. The top six states — all of which earned overall grades of B — ranked as follows:

1. New York

New York led with a total of 111 points out of 150 possible. The Empire State earned an A for health care access with 43 points, a B for health care affordability with 30 points, and another B for activity and lifestyle opportunities with 38 points.

2. Virginia

Old Dominion scored 106 out of 150, also with three B’s — 37 points for access, 30 points for affordability, and 39 points for activity.

3. Maryland

Maryland secured 105 points out of 150. The Old Line State earned two B’s, one from 32 points for access and the other from 30 points for affordability. For activity options, Maryland got an A with 43 points.

4. California

The Golden State racked up 93 points out of 150. California got a B for access with 39 points and an A for activity with 42 — but it earned a D in affordability with a score of 12.

5. Illinois

The Prairie State came up one point below California with an overall score of 92 out of 150. Its highest score was for access (35 points for a B), followed by 33 (another B) for activity. The Prairie State eked out a C in affordability with 24 points.

6. Louisiana

Louisiana was the last of the states to earn a score of 90 or higher out of 150. The Pelican State’s affordability score of 48 — an A — was higher than any other state’s. However, it earned C’s in access and in activity, with scores of 21 each.

On the other end of the spectrum, the six states with the lowest scores were:

45. Alabama — The Cotton State’s total score was 43 for an overall D, with a 14 (D) for access, 15 (D) for affordability, and 14 (D) for activity.
46. Idaho — Idaho ended up with 42 points for a D. Although The Gem State earned 29 points (C) for activity, its access score was 10 (D) and its affordability score was 3 (F).
47. Mississippi — An overall score of 39 points gave The Magnolia State a D. Mississippi had an access score of 17 (D), an affordability score of 12 (D), and an activity score of 10 (F).
48. (tie) Nevada — The Silver State earned a D with a total of 38 points out of 150. Its individual scores were 6 (F) for access, 3 (F) for affordability, and 29 (C) for activity.
48. (tie) South Carolina — South Carolina also received 38 out of 150, for a D. The Palmetto State’s scores were 8 (F) for access, 9 (F) for affordability, and 21 (C) for activity.
50. Wyoming — The Equality State ended up with 37 points, one less than Nevada and South Carolina. Like them, it earned a 6 (F) for access and for affordability. Its activity score was 25 (C).

Ankylosing Spondylitis and the Weather

Health care access and affordability, along with access to activities that support a healthy lifestyle, are important factors to consider if you’re looking to relocate. Weather, too, can affect your joint pain and quality of life with ankylosing spondylitis.

People with AS often point to cold, damp weather and changes in barometric pressure as the cause of flares. “I find that my symptoms are worse when the weather is cold,” shared one member of MySpondylitisTeam.

Another shared that the changing temperatures worsened the symptoms of ankylosing spondylitis: “This weather is very funny. Hot one minute, cold the next. I have a little lower back pain and neck pain, and have been lying down all morning. This weather will keep me in bed all day.”

According to the University of Chicago, temperature drops may worsen symptoms in people with some types of arthritis because lower barometric pressure causes tendons and other tissue to expand. This compresses joints and worsens inflammatory arthritis symptoms.

On the flip side, other MySpondylitisTeam members say the heat is worse than the cold for their symptoms. “I’m ready for fall and cooler temps … even winter hibernation,” another member said.

A 2021 study in BMC Musculoskeletal Disorders found that males and people under age 65 living with ankylosing spondylitis were more vulnerable to damp weather. The same study found that high temperatures worsened symptoms in those over 65 years old.

Said one member, “Clouds and rainy weather conditions in Maryland are causing me flare-ups.”

There is also some association between ankylosing spondylitis and low vitamin D levels. Because the best source of vitamin D may be from the sun, a sunnier climate may be better than one where most days are cloudy or overcast. One member described how their symptoms felt on a summer day: “I got to swim in a friend’s pool today. The water was cold, but after I got in and acclimated, I was good. Went home to take a hot shower, and that felt great! So after a week of pain, today has been much better.”

Don’t forget to consider the weather’s effect on your mood. Mental health has a large daily impact on life with a chronic condition such as AS. One member shared, “I am feeling so very depressed today. I live in New Jersey, and it is cold here today. At least the sun is out.”

If You’re Considering Moving

Where you live can significantly impact your daily quality of life, whether it’s the weather triggering your symptoms or the health care available to you. Finding a rheumatology center or a health care facility that will ensure you have access to diverse treatment options, such as disease-modifying antirheumatic drugs (DMARDs) and anti-inflammatory drugs, is a high priority. Your health care provider or insurance company may be able to help you find a new health care team. It’s best to establish care with a physician as soon as you move to prevent any lapse in your treatment.

Relocating may also affect your health insurance options and savings. Check with your provider to determine how moving may affect your coverage.

Ultimately, deciding where to live is a complex decision that includes many factors to support your best health. One MySpondylitisTeam member reported that the climate may or may not make a significant difference in your health: “I grew up in Idaho with mild summers, snow drifts, and subzero temperatures in the winter. I lived in Arizona with heat so extreme and dry that you can spit dust. Now, I live in California, which has four months of rain per year. Moving is about picking your poison. In total, I have lived in seven states, and I have learned that you can feel like crap in any place.”

This highlights the importance of considering other personal factors, such as proximity to family members and a support network. Be sure to make time to study your prospective state’s access and affordability of health care, which may prove more important than weather in making your life with spondylitis easier.

Get Support From People Who Understand

On MySpondylitisTeam, more than 91,000 members come together in a support group atmosphere to ask questions, give advice, and share their stories with others who understand life with ankylosing spondylitis.

Where do you live, and how does it affect your life with ankylosing spondylitis? Does the weather change your symptoms? Comment below, or start a new conversation on MySpondylitisTeam.