From the Guidelines
Rheumatoid arthritis is the primary type of arthritis that causes morning stiffness lasting over an hour, which improves throughout the day with activity, and its treatment should be initiated as early as possible with disease-modifying antirheumatic drugs (DMARDs) like methotrexate, according to the most recent guidelines 1. The clinical features of rheumatoid arthritis include symmetric polyarthritis with joint swelling, especially of the hands and feet, and patients experience morning stiffness that lasts 1 hour or longer, as described in a study published in the Mayo Clinic Proceedings 1.
- Treatment options for rheumatoid arthritis include:
- Non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (400-800mg three times daily) or naproxen (500mg twice daily) for symptom relief
- DMARDs such as methotrexate (starting at 7.5-10mg weekly, potentially increasing to 20-25mg) as the cornerstone of treatment to slow disease progression
- Other DMARD options like hydroxychloroquine (200-400mg daily), sulfasalazine (1000-3000mg daily in divided doses), and leflunomide (10-20mg daily)
- Biologic agents like TNF inhibitors (adalimumab, etanercept) or JAK inhibitors for more severe cases
- Corticosteroids like prednisone (5-10mg daily) for rapid relief during flares, but not recommended for long-term use due to side effects
- Non-pharmacological approaches include physical therapy, regular exercise, hot/cold therapy, and joint protection techniques, as recommended by the European League Against Rheumatism (EULAR) guidelines 1. The morning stiffness in rheumatoid arthritis occurs because inflammatory cytokines accumulate in joint fluid during periods of inactivity, and movement helps disperse these inflammatory mediators, explaining why symptoms improve throughout the day. Early treatment is crucial as rheumatoid arthritis can cause permanent joint damage if left untreated, and the goal of treatment is to achieve clinical remission, with regular monitoring of disease activity, adverse events, and comorbidities guiding decisions on choice and changes in treatment strategies 1.
From the FDA Drug Label
Naproxen has been studied in patients with rheumatoid arthritis, osteoarthritis, juvenile arthritis, ankylosing spondylitis, tendonitis and bursitis, and acute gout. Improvement in patients treated for rheumatoid arthritis was demonstrated by a reduction in joint swelling, a reduction in duration of morning stiffness, a reduction in disease activity as assessed by both the investigator and patient, and by increased mobility as demonstrated by a reduction in walking time. In patients with ankylosingspondylitis, naproxen has been shown to decrease night pain, morning stiffness and pain at rest.
The type of arthritis that causes morning stiffness that improves throughout the day is rheumatoid arthritis and ankylosing spondylitis. The treatment options for these conditions include naproxen, which has been shown to reduce morning stiffness and improve disease activity. Other treatment options may include aspirin, indomethacin, gold salts, and corticosteroids, although the use of naproxen in combination with these medications should be approached with caution due to potential increased risk of adverse events 2. Key benefits of naproxen include:
- Reduction in duration of morning stiffness
- Reduction in disease activity
- Increased mobility
- Decrease in night pain and pain at rest
- Fewer gastrointestinal and nervous system adverse effects compared to aspirin and indomethacin.
From the Research
Type of Arthritis
- Rheumatoid arthritis is a type of arthritis that causes morning stiffness that improves throughout the day 3, 4.
- Morning stiffness in rheumatoid arthritis is characterized by slowness or difficulty moving the joints when getting out of bed or after staying in one position too long, which involves both sides of the body and gets better with movement 4.
Treatment Options
- Treatment options for rheumatoid arthritis include disease modifying antirheumatic drug therapy, such as methotrexate, as well as simple analgesia and nonsteroidal anti-inflammatory drugs for symptom control 3.
- Non-pharmacological approaches, including simple or short exercises, application of heat or a hot shower or bath, and delaying activities until later in the day, can also help manage impaired morning function in rheumatoid arthritis 5.
- Modified-release prednisone tablets taken at bedtime can help reduce morning stiffness in patients with rheumatoid arthritis by suppressing the pro-inflammatory cytokine interleukin-6 5.
- Glucocorticoids can also significantly increase the range of motion and reduce stiffness in patients with rheumatoid arthritis 6.
Assessment of Morning Stiffness
- Morning stiffness can be quantified using a novel technology that assesses passive resistance of the MCP III joint and its passive range of motion, allowing for personalized medication and efficacy evaluation in the treatment of rheumatoid arthritis 6.
- The severity and diurnal improvement of morning stiffness can be independently associated with tenosynovitis in patients with rheumatoid arthritis, and evaluating morning stiffness can provide an independent value in the management of rheumatoid arthritis 7.