11 Effects of Rheumatoid Arthritis on the Body
Managing Morning Stiffness From Rheumatoid Arthritis
Morning stiffness is a hallmark of RA, making it hard to get out of bed. Learn about relieving RA stiffness and improving mobility.
By Karen Appold
Medically Reviewed by Farrokh Sohrabi, MD
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Do your RA symptoms greet you at the start of every new day? Morning stiffness, a sign that your rheumatoid arthritis (RA) is active, makes it hard to move your joints. Joint stiffness can affect any joint, but you’re most likely to feel it in your hands, feet, hips, knees, and spine. Most problematic is that it can keep you feel achy for the first hour of your morning, making many people dread the dawn.
In fact, morning stiffness has such an impact on daily life that a British study, published in theJournal of Medical Economics,found that easing this single RA symptom leads to significant improvement in quality of life. And yet, ironically, there's no research to show just how pervasive the problem is. But if you have morning stiffness from RA, you probably don’t need a study to tell you that you’re in distress and that improving mobility is an RA must-do.
Morning Stiffness: an RA Quandary
The cause of morning stiffness from RA isn’t fully understood, but there’s a chain reaction that goes something like this: Joint inflammation causes swelling in the joint, which increases when the joint is immobile; this results in limited mobility and tightening of muscles around the joints. It makes sense that the stiffness is often worse when the joint has been at rest, like when you've been sleeping or sitting for a long time. Though you might feel too achy too move, this stiffness improves with activity.
Relieving RA Stiffness
To get going in the morning, try these strategies for improving mobility with RA, starting while you’re still in bed:
Start with gentle movements.Maura Daly Iversen, PT, DPT, SD, MPH, a professor who chairs the physical therapy department at Northeastern University in Boston, suggests slowly moving the affected joints through their range of motion in bed before standing. This means taking a joint through its full arc of motion without pulling or stretching. Dr. Iverson recommends improving your mobility with RA by doing wrist, neck, and shoulder circles and bending and extending fingers, elbows and knees.
Targeted stretches done in bed can help, too. Sandy B. Ganz, PT, DSc, GCS, a physical therapist at the Palm Beach Institute of Sports Medicine in Boca Raton, Fla., offers the following tips:
- To decrease stiffness, begin by stretching the stiff joint. Stretch each joint that is stiff two to three times, holding the stretch for 20 to 30 seconds.
- Move slowly; do not force movement. Fast, jerky movements will make a tight, stiff joint feel worse.
- Move the joint just until you feel a stretch. This should not cause pain. It’s important to not overstretch.
Consider working with a physical therapist to get your own personalized exercise program, recommends Patience H. White, MD, vice president of public health at the Arthritis Foundation and a professor of medicine and pediatrics at George Washington University School of Medicine and Health Sciences in Washington, D.C.
Try heat therapy.Soothe joints while still in bed with a heated blanket or, as soon as you get out of bed, take a warm bath or shower, Dr. White says.
Do a few minutes of exercise."You will feel better when you move because the swelling decreases," White explains. Just five minutes of movement can ease discomfort. Combine two tips by doing your range-of-motion exercises in the shower, or gently pedal on a stationary bicycle at a comfortable pace to relieve RA stiffness in the ankles, hips, and knees.
Take your meds from bed.Medications can help to control morning stiffness from RA by reducing the inflammation. Some nonsteroidal anti-inflammatory drugs , or NSAIDs, are sold over-the-counter, but stronger ones are available by prescription only. These drugs help to ease arthritis pain and inflammation, White says. NSAIDs include ibuprofen (Advil, Motrin), ketoprofen (Nexcede), and naproxen sodium (Aleve), among others. If you have had or are at risk for stomach ulcers, your doctor may prescribe celecoxib (Celebrex), a type of NSAID called a COX-2 inhibitor, which is designed to be safer for the stomach. Keep your meds on your nightstand, along with water, so that they’re within reach when you wake.
Rub in a joint cream.Products such as diclofenac gel (Voltaren Gel) may help relieve RA pain and stiffness. Note that diclofenac is an NSAID, and too many NSAIDs are not a good thing. If you take an oral NSAID, you should check with your doctor before adding an NSAID gel to your RA toolkit.
Be sure to get enough vitamin D and calcium.Corticosteroids (anti-inflammatory medications given orally or by injection), can affect bone strength, and calcium and vitamin D are important nutrients for bone health. Ask your doctor or nutritionist about your nutrient needs to keep bones healthy and keep you moving.
Consult with anoccupational therapist.If you get morning stiffness from RA in your hands or wrists, this medical professional can give you splints that will keep your hands in a good position overnight. "When you start your day, your hand will not be in a tight fist," White says. "By having your hand in an open, resting position, it will be easier to get it moving in the morning."
Buying Time: Tips for Your Workplace
A German study published in the journalRheumatologyfound that the more severe their morning stiffness, the more likely people were to think about early retirement — a situation that you might not be financially or emotional ready for. The researchers concluded that any morning stiffness should be managed as early and effectively as possible so that you can continue in your career.
Talk to your employer about small but helpful accommodations to help you stay productive on the job. Having a flexible work schedule could get you the extra time you need to get moving in the morning. Also try to modify your posture during work. For example, if you sit a lot, try standing occasionally. Use a footstool to change your lower back position. Also, take frequent breaks to move around as joint stiffness isn’t limited to the morning.
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