What Is Morning Stiffness?
Feeling stiff when you first wake up in the morning is a common problem of arthritis. Morning stiffness causes you to hurt all over as you get out of bed. As you take your first steps, your joints and muscles ache so much, you want to crawl right back in bed. In fact, morning stiffness can be the most severe pain you feel all day and it can impair or interfere with your ability to function and perform routine tasks.
Paying attention to the duration of your morning stiffness (how long it lasts) will help both you and your doctor decide how to deal with it. Morning stiffness that lasts more than an hour and -- in some cases up to several hours -- is characteristic of rheumatoid arthritis or other inflammatory types of arthritis. Morning stiffness that is less prolonged (typically a half hour or less) is more likely to be osteoarthritis or another non-inflammatory, musculoskeletal condition. In spite of having a regular treatment regimen, morning stiffness is a persistent problem for many arthritis patients.
What Causes Morning Stiffness?
One theory about morning stiffness is referred to as the gel phenomenon. The gel phenomenon essentially means that stiffness develops after long periods of sitting or inactivity. This is characteristic of non-inflammatory conditions.
Some researchers note that morning stiffness is a circadian symptom that is not fully understood. Some suspect there may be insufficient cortisol released in the body during the night to offset elevated pro-inflammatory cytokines like IL-6, but waking up in the middle of the night to take glucocorticoids to reduce the inflammation would be inconvenient and not without its own side effects.
Tips for Dealing With Morning Stiffness
There actually has been a modified-release prednisone tablet developed. Taken at approximately 10 p.m., the tablet delivers a dose of prednisone to the body about 4 hours later, which is considered the best time to suppress IL-6. Some clinical studies have suggested this is the way to manage morning stiffness. The drug, called Lodotra, has performed well in studies but it is not FDA approved, as of yet. If you have inflammatory arthritis, managing morning stiffness involves working with your doctor to control the inflammation. But no matter what type of arthritis you have, here are some tips that may help:
- Sleep in a position that supports your joints.
- Be sure that your bedroom or sleep environment is warm. Dial-up a comfortable temperature on the thermostat and use heating pads and electric blankets for extra warmth.
- Before getting out of bed, do simple stretching exercises in bed to limber up.
- When you first get up, take a hot shower -- just stand under the water and relax.
- Do a few more exercises, once your muscles begin to loosen up.
- Easier said than done, but when you go to bed, leave work and problems at the door to try to reduce tension.
- If possible, delay your activities until later in the day. If you work, consider requesting a later start time.
Managing morning stiffness is essential. Morning stiffness affects your level of frustration, ability to work, and overall quality of life. It's worth your effort to try to reduce morning stiffness -- even a little bit would go a long way.
Impact of impaired morning function on the lives and well-being of patients with rheumatoid arthritis. da Silva JA et al. Scand J Rheumatol Suppl. 2011;125:6-11. http://www.ncbi.nlm.nih.gov/pubmed/21529304
How should impaired morning function in rheumatoid arthritis be treated? Buttgereit F. Scand J Rheumatol Suppl. 2011;125:28-39. http://www.ncbi.nlm.nih.gov/pubmed/21529308