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Joint Stiffness and Rheumatoid Arthritis

 Originally published in WebMD

Joint stiffness is a hallmark of rheumatoid arthritis (RA), a chronic disease that affects 1.3 million adult Americans. Resulting from an abnormal response of the immune system, rheumatoid arthritis inflames the soft tissue that lines the surface of joints (called the synovium). It is a systemic disease that not only makes joints stiff and painful, but can also affect other parts of your body, such as internal organs.

By noting symptoms such as joint stiffness and seeking early treatment, you can feel better, slow or stop progression of the disease, and minimize joint damage. This allows you to live a more active, full life.

Self-Assessment: Are You Doing All You Can to Manage Your Rheumatoid Arthritis?

Joint Stiffness: Early Sign of Rheumatoid Arthritis

How well you can move an arm, leg, or finger in different directions reflects the joint’s range of motion. If you develop joint stiffness, your range of motion is reduced. Your joint doesn’t move as well as it once did.

Joint stiffness may occur with or without joint pain. Other signs and symptoms in addition to the joint stiffness will help your doctor figure out what kind of arthritis you have.

With rheumatoid arthritis, joint stiffness and other symptoms such as pain or fatigue tend to develop and worsen over several weeks or months. Joint stiffness is most noticeable in the morning and may not improve for an hour or two. Sometimes it lasts throughout the day.

Joint stiffness from RA often affects these areas:

  • Joints of the fingers and hands
  • Wrists
  • Elbows
  • Knees
  • Ankles
  • Feet

Shoulders, hips, and jaw may also be affected. At least two or three different joints are involved on both sides of the body.

Rheumatoid arthritis progresses in three stages.

  • During the first stage, the lining of the joint becomes inflamed. This causes stiffness, pain, warmth, redness, and swelling around the joint. Severe morning stiffness, which can limit your ability to function, is often the very first sign of the disease.
  • During the second stage, the rapid division and growth of cells causes the synovium to thicken.
  • During the third stage, the inflamed cells release enzymes that may digest bone and cartilage. This often causes: more pain, joints to lose their shape and alignment, and loss of movement.

 

Joint Stiffness: Risk Factor for Early Joint Damage

How quickly joint damage occurs with rheumatoid arthritis varies from person to person and depends on many factors. In addition to signs such as inflammation or certain antibodies that can be measured with tests, risk factors for early joint damage may include:

  • Stiffness, pain, and swelling in many joints
  • Joint stiffness and swelling every day
  • Joint stiffness that lasts a long time in the morning

The more risk factors you have, the more important it is to get early treatment.

Tracking Symptoms of Joint Stiffness and Pain

Symptoms such as joint stiffness and pain can tell your doctor a lot about your type and extent of arthritis. That’s why it’s so important for you to keep track of your symptoms. Keeping a symptom chart for a few weeks can help confirm a diagnosis of rheumatoid arthritis.

Before you see your doctor, make a list of your symptoms and describe when they occur. Do they occur after a particular activity or first thing in the morning? Note when joint stiffness and other symptoms first began, whether they came on suddenly or have recurred, and whether they’ve changed in intensity over time or moved to new joints.

Physical Exams: Checking for Joint Stiffness

See a doctor to assess joint stiffness, pain, or swelling that lasts more than two weeks. Your doctor may refer you to a rheumatologist, a doctor trained in the diagnosis and treatment of arthritis and other diseases of joints, muscles, and bones.

Bring information about your joint symptoms and note whether you have any that are unrelated to your joints, such as fatigue or weight loss. Pain is often a partner to joint stiffness. Do your best to describe it. You may think of joint stiffness as a type of vague muscle ache. That’s partly because symptoms may be subtle at first. Your doctor will confirm the presence of joint stiffness as discomfort you experience when trying to move.

The doctor will assess your joint’s mobility. You may be asked to move the joint to check its active range of motion. If the doctor moves the joint to examine its mobility, this is called passive range of motion. Your doctor will also check your joint for swelling, enlargement, and tenderness.

A variety of tests can help your doctor evaluate your joints and check for signs of systemic disease.

Treating Joint Stiffness

Pay attention to early signs and symptoms of rheumatoid arthritis, such as joint stiffness. Early, aggressive treatment can greatly limit joint damage. Your doctor will help you develop a plan for treatment, which may include medications and several types of therapy. 

Medications. A variety of medications are used to treat rheumatoid arthritis. When given early enough, some interrupt the progression of the disease by reducing inflammation and preventing joint damage. Others help relieve symptoms of joint stiffness and pain. 

You may take a combination of medications, such as:

  • Disease-modifying anti-rheumatic drugs (DMARDs)
  • Biologic response modifiers (a category of DMARDs)
  • Glucocorticoids
  • Nonsteroidal anti-inflammatory medications (NSAIDs)
  • Analgesics

Therapies. A program of physical therapy and exercises can help improve mobility, reduce pain, and increase flexibility and strength. Heat — delivered through hot packs, electric mittens, ultrasound, or spas, for example — can help relieve joint stiffness and pain. Hydrotherapy involves exercising and relaxing in warm water. Cold works best for acutely inflamed joints. Relaxation techniques help release muscle tension, relieving stiffness and pain. An occupational or physical therapist can teach you how to use your body so you can reduce stress on your joints, for example, by using the strongest joint available to do a job. This is called good body mechanics.

Self-Care for Joint Stiffness and Pain

You can take other steps as well to help relieve joint stiffness and pain. For example, weight control reduces stress on joints. Exercise can also strengthen muscles and joints. Water aerobics is a good choice. It improves your range of motion without putting extra stress on joints.

To protect your joints, alternate between periods of rest and activity. But at least once a day, gently move your joints through their range of motion. If needed, use assistive devices to reduce joint stress and relieve pain.

Keep an eye out for new nutrition developments. For example, several studies report that regularly taking fish oil supplements for up to three months can improve morning stiffness and joint tenderness associated with rheumatoid arthritis. Researchers have also shown that fish oil can improve the effects of anti-inflammatory medications. More studies are needed to confirm these reports.

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