Why are my joints stiff in the morning?
During sleep, the joint hardly moves. If there is inflammation in it, the synovial membrane secretes excess fluid and swells, and interstitial fluid accumulates in the surrounding tissues. In the morning, this is felt as swelling and stiffness, which gradually goes away as you move: muscle work improves the outflow of fluid. The more active the inflammation, the longer the stiffness lasts. With osteoarthritis, inflammation is minimal, and stiffness after sleep is short-lived, and pain comes to the fore during exercise and at the end of the day.
- Swelling of the synovium due to inflammation
- Fluid accumulation at rest
- Improvement with movement and warm-up
- Duration reflects inflammatory activity
- With arthrosis, the stiffness is short, the pain is associated with exercise
Duration as a hint
The doctor always clarifies how many minutes the stiffness lasts and when it is maximum. Up to 30 minutes - typical for osteoarthritis, overload, hypothyroidism and normal muscle tension. From 30 minutes to several hours is a characteristic sign of inflammatory arthritis: rheumatoid, psoriatic, and systemic connective tissue diseases. Stiffness in the lower back and thoracic region, which torments in the second half of the night and decreases with warm-up, is typical of ankylosing spondylitis and is often mistaken for years for ordinary osteochondrosis.
- Up to 30 minutes: arthrosis, overload, hypothyroidism
- More than 30–60 minutes: inflammatory arthritis
- Symmetrical hand and foot: rheumatoid arthritis
- Lower back stiffness at night: spondyloarthritis
- Shoulders and hips after 50 years: polymyalgia rheumatica
- Stiffness with psoriasis: psoriatic arthritis
Associated symptoms
The diagnosis is rarely made by stiffness alone, so it is important to look for other manifestations as well. Inflammatory diseases are characterized by swelling of the joints, fatigue, unmotivated weakness, low-grade fever, and sometimes weight loss. Psoriatic arthritis is often accompanied by skin plaques and changes in the nails, reactive arthritis is often accompanied by a recent intestinal or urogenital infection, or inflammation of the eyes. Systemic lupus erythematosus may cause a rash on the face, mouth sores, hair loss, and sensitivity to the sun.
- Swelling and tenderness of the joints
- Weakness and fatigue
- Low-grade fever
- Skin rashes and nail changes
- Eye inflammation
- Dry mouth and eyes
- Pain in heels and tendon attachments
Survey
They begin with an examination: the doctor counts the number of swollen and painful joints, assesses the mobility of the spine, and examines the skin and nails. The laboratory minimum is a complete blood count, ESR and CRP as indicators of inflammation. If rheumatoid arthritis is suspected, rheumatoid factor and antibodies to cyclic citrullinated peptide, which are more specific, are determined. Ultrasound of the joints reveals inflammation of the synovial membrane even where the swelling is not visible to the eye. X-rays show changes that develop later, so a normal X-ray at the onset of the disease does not rule out arthritis.
- Complete blood count, ESR, CRP
- Rheumatoid factor
- Antibodies to CCP
- Ultrasound of joints
- X-ray of hands, feet, pelvis
- TSH for suspected hypothyroidism
- Consultation with a rheumatologist
What to do
The main rule: long-term stiffness is not an age-related feature and is not a reason to buy chondroprotectors at random. With inflammatory arthritis, time is of decisive importance: basic therapy, begun in the first months of the disease, preserves the joints from destruction, and treatment delayed for years no longer returns the lost function. Before seeing a doctor, a warm shower in the morning, gentle exercises in bed, regular physical activity and quitting smoking, which aggravates rheumatoid arthritis, help. Pain medication relieves symptoms, but does not replace diagnosis.
- If you feel stiff, do not delay your visit for more than 30 minutes.
- Warm shower and warm-up in the morning
- Regular feasible physical activity
- Quitting smoking
- Weight control
- Basic therapy as prescribed by a rheumatologist
- Refusal of self-medication with hormonal drugs