Causes of Morning Stiffness From Arthritis

Morning stiffness is common in people with arthritis. When it's severe, you may feel like you can hardly walk when you get up in the morning. Sometimes it can even happen if you are being treated for arthritis.

It can affect those with osteoarthritis, rheumatoid arthritis, and psoriatic arthritis, and is due to a variety of factors. 

This article explains the possible causes of morning stiffness in arthritis and what you can do to make your mornings less painful.

Causes of Morning Stiffness

Morning stiffness is common in different types of arthritis, including rheumatoid arthritis (RA), psoriatic arthritis (PsA), and osteoarthritis (OA).

The symptoms of morning stiffness can vary depending on the type of arthritis you have. For example: 

• In RA or another type of inflammatory arthritis, morning stiffness will likely last more than an hour—or even several hours.
• With PsA (which occurs with psoriasis), joint stiffness and pain are often worse in the morning, and the symptoms can last for 30 minutes or more.
• Morning stiffness that goes away within a half hour or less after waking up is more typical in OA or another non-inflammatory musculoskeletal condition.

Gel Phenomenon

One possible cause of morning stiffness is called the "gel phenomenon."

In your joints, there's a liquid called synovial fluid. When your joints are not moving, the fluid can get thick and “gel-like.” The gelling makes it harder for the joints to move easily. However, once you start moving again, the fluid will go back to its normal liquid state.

The gel phenomenon is one reason why people with OA may feel stiff after long periods of inactivity.

Low Cortisol

Some researchers think that morning stiffness could be related to hormone fluctuations in the body over a 24-hour cycle. It's thought that some conditions make a person have low nighttime levels of the hormone cortisol.

Having low cortisol overnight leaves your body unable to tamp down cells called pro-inflammatory cytokines, such as interleukin-6 (IL-6). Since the inflammation isn’t under control while you sleep, you wake up with extra inflammation. More inflammation contributes to arthritis symptoms like pain and morning stiffness, particularly for people with an inflammatory form of arthritis. 

Your cortisol levels tend to be highest (peak) in the morning. As the day goes on and the levels and inflammation go down, your arthritis symptoms may gradually get better, too.

Role of Obesity

There are a few ways that obesity is linked to arthritis, particularly “wear and tear” OA. 

Carrying extra weight puts more stress on your joints, especially on your hips and knees. It can also make the weakening and damage of cartilage in joints (degeneration) move at a faster pace. There’s also some evidence that obesity is linked to inflammation in the body, and inflammation is linked to arthritis.

If you have obesity, you may notice stiffness in your joints in the morning as well as throughout the day. If you can lose weight and maintain a weight that supports your health, it could help with your arthritis symptoms. 

Role of Vitamin D Deficiency

Vitamin D plays a key role in bone and joint health and is an important nutritional aspect of taking care of these parts of your body. That said, being deficient in vitamin D can cause joint pain and stiffness in the morning, even in people who do not have arthritis. For people who do have forms of arthritis, vitamin D might play a role in helping them manage the disease.

Some research has shown an association between low vitamin D levels and joint pain, particularly in the knee and hip.

One 2017 study found that increasing vitamin D intake might be beneficial for people who have arthritis pain and a vitamin D deficiency but was not necessarily helpful for people who have adequate vitamin D levels. More studies are needed to find out if additional vitamin D would be beneficial for people with arthritis who are not deficient.

Dealing With Morning Stiffness

You might be able to manage morning stiffness with medication or changes in your daily routines or lifestyle habits. You can also talk to your provider about specific treatments that might help, depending on the type of arthritis you have. 

For example, a prescription drug called Rayos is a delayed-release form of a corticosteroid called prednisone, which is a powerful anti-inflammatory medication. Rayos can help with morning stiffness because it’s usually taken around 10 p.m., and the medication gets released about four hours later (which is thought to be the best time to suppress IL-6).

You can also cope with morning stiffness from arthritis by:

• Supporting your joints while you sleep (for example, with pillows or braces). 
• Staying warm by using electric blankets or heating pads or turning up the thermostat.
• Doing simple stretching exercises before you get out of bed.
• Taking a hot shower first thing in the morning to relax your joints and muscles.
• Fitting in some light exercise once you begin to loosen up.
• Trying to let go of stress before going to bed.
• Delaying activity until later in the day, if possible. For example, asking for a later start time at work or not making appointments early in the day.

You may have to experiment with more than one method until you find one (or a combination of several) that helps you manage morning stiffness and cope with the effects of arthritis in your day-to-day life. 

Summary

Morning stiffness is common in people with different kinds of arthritis. In inflammatory types of arthritis, morning stiffness may last for several hours. In non-inflammatory forms of arthritis like osteoarthritis, morning stiffness generally goes away in less than half an hour.

Morning stiffness can have different causes, like the "gelling" of joint fluid or low overnight cortisol levels, leading to inflammation. Talk to your provider about medications or lifestyle changes that may help you cope with morning stiffness from arthritis.