Morning stiffness — along with pain, swelling and redness around the joints (all signs of inflammation) — is a common challenge for people living with rheumatoid arthritis (RA). Waking up with stiff joints is also a sign that the condition is not under control.
“Whenever someone comes for consultation or a follow-up, the first thing we ask about is the early morning joint stiffness,” says Dr Shweta Singhai, consultant rheumatologist at the Sakra World Hospital, Bangalore. “If it is absent, then it is a sign that the situation is under control.”
Stiff joints in the morning are also seen in degenerative conditions such as osteoarthritis. “The initial symptom of any arthritis is stiffness,” says Dr Singhai. “We can differentiate whether it is due to some degenerative arthritis (like osteoarthritis) or because of any inflammatory condition (like RA) by looking at the duration.”
If the stiffness lasts for less than half an hour, then it is generally due to a degenerative condition. And if the stiffness remains for a longer duration, then it is usually rheumatoid arthritis or arthritis related to any other connective tissues. “The stiffness can last for three to four hours,” adds Dr Singhai. “Sometimes it can also last longer than that.”
Causes for morning stiffness in rheumatoid arthritis
One of the main reasons behind the occurrence of stiff joints in the morning is the release of interleukin (a type of protein made by certain cells in the body) during sleep. A 2011 research paper shows how the increase in nocturnal cortisol secretion is insufficient to suppress ongoing inflammation, which results in morning symptoms such as stiffness.
“Certain chemicals called cytokines have a diurnal variation [systemic variation over the length of the day],” says Dr Singhai. “And certain cytokines like interleukins are secreted during sleep, causing an increase in stiffness. Secondly, the body secretes some steroids called endogenous steroids. These are needed for our day-to-day activities. When the RA condition is intense, these steroids are unable to counteract the inflammation, leading to stiffness.”
How to prevent morning stiffness
Sticking to the doctor-recommended drug therapy and regular follow-ups with the rheumatologist are important to avoid the symptoms of rheumatoid arthritis, including morning stiffness.
People who experience early morning joint stiffness can also add certain helpful measures to their daily routine. “We ask people who have a minimal stiffness to take a warm water bath in the morning because it relaxes and releases the joints, resulting in a decrease in morning stiffness,” says Dr Singhai. “Individuals can also do gentle exercises with a small range of motions to ease up the joints.”
Some people consume painkillers to deal with the pain caused by the stiffness. But painkillers only reduce the pain — with no effect on the rheumatoid arthritis condition.
“The main cause of the pain is inflammation,” says Dr Singhai. “If painkillers are taken, then the pain will go away, but the condition remains. So, modifying agents are needed to reduce the inflammation. Painkillers are advised only for a short-term course.”
Treatment for rheumatoid arthritis should start within the first three months of the diagnosis. Sometimes people go looking for other modes of treatment for dealing with the pain and stiffness, leading to a delay. The risk in such a situation is that the delay could eventually lead to deformities, which are normally non-reversible. If ignored, rheumatoid arthritis also starts affecting other body parts like the lungs, eyes, skin and heart.
Takeaways
- Morning stiffness is among the major symptoms of rheumatoid arthritis. One reasons for its occurrence is the release of certain cytokines (chemicals) during sleep.
- Morning stiffness can occur in all types of arthritis. If the joints remain stiff for less than half an hour, then it is usually a case of a degenerative condition like osteoarthritis. If they remain stiff for a longer period, then it is mostly because of rheumatoid arthritis.
- Morning stiffness won’t occur if the individual’s rheumatoid arthritis is under control.
