Morning stiffness is a common problem for people with rheumatoid arthritis (RA). A recently published article in Drugs & Aging reviewed evidence that anti-inflammatory drugs can help reduce morning stiffness. Morning stiffness with rheumatoid arthritis.

We depend on our immune system to protect us from bacteria and viruses. However, there are diseases where the immune system turns against the body, which it must protect. With rheumatoid arthritis, the immune system affects the joints. Over time, this can lead to joint damage. This will lead to significant pain, impaired mobility, and reduced quality of life.

Joint pain and stiffness experienced by people with rheumatoid arthritis are usually worse in the morning. This morning stiffness can be difficult and debilitating. There are many types of medications that can reduce the severity of rheumatoid arthritis, and some of them can also reduce stiffness.

A Hong Kong rheumatologist wrote a review article summarizing the results of a study of morning stiffness and whether recent anti-inflammatory drugs that have been developed can reduce their severity.  Diagnostic methods of RA .

Morning stiffness in rheumatoid arthritis

How serious is morning stiffness in rheumatoid arthritis?

In one clinical study, more than two-thirds of patients with rheumatoid arthritis experienced stiffness in the morning. A quarter of patients experienced morning stiffness for at least an hour. Another study found that in half of patients stiffness lasted longer than an hour. Interestingly, another study showed that the duration of morning stiffness decreased in patients who had rheumatoid arthritis longer. The review also noted that morning stiffness studies usually measure only the duration of stiffness, and not the severity of pain or the degree of disability.

Morning stiffness can significantly affect a person’s morning functions, as well as his daily life and social life. People with severe morning stiffness often retired earlier. And patients with more severe morning stiffness were more likely to not work at all.

In another study of retirees from the Republic of Armenia, the majority stated that they had to stop working before reaching their normal retirement age. Most of these early retirees said morning stiffness was the main reason for their retirement. Nearly half of working people with rheumatoid arthritis said that morning stiffness adversely affected labor productivity. Almost a third of respondents say that because of their morning stiffness, they are late for work. How to cope with RA ?

Do new anti-inflammatory drugs make morning stiffness easier?

Over-the-counter anti-inflammatory drugs, such as aspirin or ibuprofen, can temporarily relieve pain or stiffness. But they do not affect the long-term prognosis of the underlying disease. Other medicines, such as methotrexate, have been commonly used to treat rheumatoid arthritis. They work through various biological mechanisms.

In recent decades, researchers have developed new anti-inflammatory drugs that are designed to specifically target and suppress individual proteins involved in inflammation and the immune response. The targeted nature of these drugs is designed to make them safer and more effective than previous treatments. These drugs include adalimumab (Humira), baricitinib, etanercept (enbrel), infliximab (remicad), rituximab (mabtera or rituxan), sarilumab (kevzara), and tocilizumab (actemra).

Clinical trials have confirmed the effectiveness of these drugs for the treatment of rheumatoid arthritis and morning stiffness. It was found that all drugs reduce the average duration or severity of stiffness in the morning. Some of these trials also compared drug efficacy with placebo or conventional anti-RA treatment. Sarilumab and baricitinib were more effective than placebo in reducing the duration or severity of morning stiffness. Infliximab and etanercept were more effective in reducing the duration of morning stiffness compared to older drugs. Drug treatment .

All studies were of different designs and reflected rigidity in different ways. Therefore, it was impossible to directly compare the results of each study with each other. For example, in one study testing tocilizumab, the average duration of morning stiffness was reduced by 50% (from 2.4 to 1.2 hours) after four weeks of treatment. Another tocilizumab study found that the duration of morning stiffness was reduced in half of the patients treated. But only 19% of patients experienced a decrease of more than 1 hour. Other studies have reported even more impressive effects. For example, in patients taking infliximab, the average duration of morning stiffness decreased by 70%.

Are anti-inflammatory glucocorticoids useful in treating morning stiffness?

Glucocorticoids, such as prednisone, are a type of steroid hormone that suppresses the immune system and reduces inflammatory activity. They are very effective in reducing the severity of rheumatoid arthritis. But prolonged use can lead to serious side effects, including an increased risk of death. This risk requires careful monitoring and attention to dosage. However, the quick effect of glucocorticoids means that they can be especially effective when taking the drug in time coincides with morning stiffness. For example, recent studies have shown that taking prednisone in the early morning or delayed-release prednisone at bedtime effectively reduces stiffness in the morning. Depression with rheumatoid arthritis .

There are effective treatments for morning stiffness in rheumatoid arthritis.

Doctors may not always be careful about morning stiffness in their patients, preferring to rely on other indicators of the severity of the disease. Nevertheless, stiffness in the morning contributes greatly to the negative impact of RA on quality of life. For this reason, morning stiffness should be regularly evaluated at the clinic. This is especially true given that in many patients, medication can partially relieve stiffness in the morning. However, there is no standard practice for assessing the severity of morning stiffness. However, most clinical studies rely solely on the duration, and not on a quantitative assessment of the severity of pain. Researchers and doctors should develop a standardized method for measuring morning stiffness. To facilitate the treatment of this important consequence of rheumatoid arthritis.


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