What type of arthritis, such as Rheumatoid Arthritis (RA) or Osteoarthritis (OA), causes morning stiffness that improves throughout the day, and what are the treatment options for each, including their typical affected body regions?

From the Guidelines

Rheumatoid arthritis (RA) is the type of arthritis that typically causes morning stiffness that improves throughout the day, and its treatment options include disease-modifying antirheumatic drugs (DMARDs) like methotrexate, non-steroidal anti-inflammatory drugs (NSAIDs), and biologic agents, with the goal of achieving clinical remission and improving quality of life. This autoimmune condition primarily affects the small joints of the hands and feet symmetrically, but can also involve larger joints like knees, hips, shoulders, and elbows [ 1 ].

Key Characteristics and Treatment Options

• Morning stiffness in RA is a hallmark symptom that improves with activity throughout the day, as inflammatory mediators accumulate in joint tissues overnight and are dispersed with movement.
• Treatment options for RA include:
  • DMARDs like methotrexate, which is considered the anchor drug and should be part of the first treatment strategy in patients at risk of persistent disease [ 1 ].
  • NSAIDs like ibuprofen or naproxen for symptom relief, but should be used at the minimum effective dose for the shortest time possible due to gastrointestinal, renal, and cardiovascular risks [ 1 ].
  • Biologic agents like adalimumab or etanercept for patients who do not respond to traditional DMARDs.
  • Corticosteroids like prednisone for short-term use in flares, but with caution due to cumulative side effects [ 1 ].
• Non-pharmacological approaches, such as dynamic exercises, occupational therapy, smoking cessation, dental care, weight control, and assessment of vaccination status, are also important adjuncts to drug treatment [ 1 ].

Importance of Early Treatment and Monitoring

• Early treatment is crucial in RA to prevent permanent joint damage and improve quality of life.
• Regular monitoring of disease activity, adverse events, and comorbidities should guide decisions on choice and changes in treatment strategies to achieve clinical remission [ 1 ].
• Monitoring should include tender and swollen joint counts, patient and physician global assessments, ESR, and CRP, with assessments at 1-month to 3-month intervals until the treatment target has been reached [ 1 ].

From the FDA Drug Label

In Study III, ACR response rates and improvement in all the individual ACR response criteria were maintained through 24 months of Enbrel therapy... Enbrel was significantly better than placebo in all components of the ACR criteria as well as other measures of RA disease activity not included in the ACR response criteria, such as morning stiffness. Among patients with PsA who received Enbrel, the clinical responses were apparent at the time of the first visit (4 weeks) and were maintained through 6 months of therapy. ... Morning stiffness (minutes) 60 60 60 15

• Rheumatoid Arthritis (RA) causes morning stiffness that improves throughout the day.
• Psoriatic Arthritis (PsA) also causes morning stiffness that improves with Enbrel therapy.
• Treatment options for RA include Enbrel, which can be used alone or in combination with Methotrexate (MTX).
• Treatment options for PsA include Enbrel, which can be used alone or in combination with MTX.
• Typical affected body regions for RA include:
  • Hands
  • Wrists
  • Feet
• Typical affected body regions for PsA include:
  • Distal interphalangeal joints
  • Polyarticular joints
  • Spine (in cases of ankylosing spondylitis-like PsA) 2 2

From the Research

Arthritis Types and Morning Stiffness

• Rheumatoid Arthritis (RA) is a chronic disease that can cause irreversible joint damage and significant disability, characterized by morning stiffness that improves throughout the day 3, 4, 5.
• The morning stiffness in RA is typically symmetrical, affecting both sides of the body, and gets better with movement 5.
• Osteoarthritis (OA) is not mentioned in the provided studies as a cause of morning stiffness that improves throughout the day.

Treatment Options for Rheumatoid Arthritis

• Disease-modifying antirheumatic drugs (DMARDs) such as methotrexate, hydroxychloroquine, sulfasalazine, and leflunomide are used as first-line therapy for RA 3, 6, 7.
• Biological-response modifiers such as infliximab, etanercept, and adalimumab (inhibitors of tumor necrosis factor [TNF]-alpha) are used to treat RA, especially in patients who have had inadequate response to DMARDs 6, 7.
• Nonsteroidal anti-inflammatory drugs (NSAIDs) and glucocorticoids are used to control pain, inflammation, and stiffness related to RA 6, 7.

Typical Affected Body Regions

• RA typically affects the small joints of the hands and feet, including the metacarpophalangeal, proximal interphalangeal, and metatarsophalangeal joints, as well as the wrists and knee 3, 4.
• The distal interphalangeal, sacroiliac, and lumbar spine joints are rarely involved in RA 4.
• Hand involvement is a typical early manifestation of RA, with synovitis involving the metacarpophalangeal, proximal interphalangeal, and wrist joints 4.