Morning Stiffness in Psoriatic Arthritis : Comprehensive Management Tips”

1. Introduction

   1. Psoriatic Arthritis and its Symptoms

      Psoriatic arthritis is an autoimmune condition that affects some individuals with psoriasis, a skin disorder characterized by red, scaly patches.

      In psoriatic arthritis, the immune system mistakenly attacks the healthy joint tissues leading to inflammation, pain, and stiffness.⁽¹⁾ This condition is commonly seen affecting the joints of fingers and toes and may also involve larger joints like the knee, elbow, and spine.

      The symptoms of psoriatic arthritis vary from person to person and these include:⁽²⁾

      • Pain, swelling, redness, and a feeling of tenderness on touching the affected joints.
      • Stiffness in the joints making them more rigid and less flexible.
      • Symptoms of psoriasis include skin plaques, redness, and scaling.
      • Nails show changes including pitting, discoloration, and separation from the nail bed.
      • Chronic inflammation in psoriatic arthritis leads to general feelings of tiredness and low energy levels.
      • In some cases, psoriatic arthritis may lead to inflammation of eyes causing redness, pain, and sensitivity to light.
      • There may be stiffness and discomfort, particularly in the lower back.
      • There may be joint damage reducing the range of motion.

   2. Common Issue of Early Morning Stiffness

      Early morning stiffness is a hallmark symptom of psoriatic arthritis and is experienced by most of the individuals affected with this condition. It is characterized by pronounced stiffness and reduced flexibility in the joints on waking or after prolonged periods of rest.

      This can lead have a profound impact on the ability to initiate daily activities, affecting the overall quality of life.

      Understanding and effectively managing early morning stiffness is a critical component of comprehensive psoriatic arthritis care. It affects an individual’s mobility, comfort, and overall well-being. Addressing this issue can enhance a person’s daily functioning and maintain a higher level of independence.

2. What Makes Joint Feel Stiff in the Morning

   There is a combination of factors that make the joint feel stiff in the morning. These factors are related to both the mechanics of the joints and the body’s natural processes during sleep, which include: 

   • Reduced Synovial Fluid Production: Synovial fluid is a thick, lubricating fluid that helps cushion and lubricate the joints. During periods of sleep, the production of synovial fluid slows down leading to a feeling of pain and stiffness upon waking.⁽²⁾
   • Decreased Blood Flow: The blood circulation slows down during the periods of rest.⁽³⁾ This reduced flow of blood leads to less nutrient delivery and waste removal from joint tissue, contributing to morning stiffness.
   • Muscle Inactivity: Muscles have a crucial role in supporting and moving the joints. While sleeping, muscles are relatively inactive.⁽⁴⁾ This leads to a temporary decrease in joint flexibility and range of motion.
   • Accumulation of Inflammatory Molecules: Inflammatory molecules are associated with conditions like arthritis, and accumulate in the joint tissue overnight.⁽⁵⁾ This exacerbates stiffness, especially in individuals with psoriatic arthritis.
   • Formation of Microscopic Adhesions: While a person is immobile, small adhesions or stickiness form between joint surfaces. These can make movement more challenging, contributing to feelings of stiffness.
   • Temperature and Humidity Changes: During morning the air is cooler and more humid and affects joint tissues. Change in temperature and humidity influences the viscosity of synovial fluid and impacts joint mobility.⁽⁶⁾
   • Natural Circadian Rhythms: The natural circadian rhythms influence various physiological processes in the body including joint function. This causes joints to be stiffer in the morning as a part of biological rhythm.

   Morning stiffness can be more pronounced in those with certain medical conditions such as arthritis or other inflammatory joint disorder. Inflammation and structural changes in the joint further contribute to stiffness in walking. Stretching, gentle exercise, and warm-up routines help alleviate morning stiffness and improve joint mobility. If morning stiffness is severe or persistent, it is advisable to consult a healthcare provider for proper evaluation and management.

3. Is it Possible to Prevent Early Morning Stiffness in Psoriatic Arthritis?

   Psoriatic arthritis has no cure, but it is possible to ease the symptoms of early morning stiffness and pain and feel better.

   Learning about the triggers and avoiding them can be helpful. Also, early diagnosis and treatment can help relieve symptoms and prevent disease progression that could cause more severe symptoms.⁽⁷⁾

   The strategies that can be helpful in minimizing the impact of psoriatic arthritis include: 

   • Medication Management: Adhering to prescribed medications including disease-modifying anti-rheumatic drugs, nonsteroidal anti-inflammatory drugs, and biologic therapies can be helpful in managing inflammation and reducing morning stiffness.

   Corticosteroids can be injected into the joints to reduce pain and swelling.⁽¹⁰⁾ A study found that apremilast improved joint stiffness, pain, and function in as little as 2 weeks period.⁽¹¹⁾

   • Regular Exercise and Stretching: Engaging in regular and gentle exercises and stretching routines can help improve joint flexibility and reduce stiffness. An appropriate exercise plan can be developed by a physical therapist along with the guidance of a healthcare provider for the best result.⁽⁸⁾

   According to a review, physical activity can positively affect the activity, well-being, and comorbidities in people with psoriatic arthritis.⁽⁹⁾

   • Maintaining a Healthy Weight: Excess weight exacerbates stress on the joints and inflammation. Maintaining a healthy weight through a well-balanced diet and regular exercise can help alleviate symptoms of joint strain.
   • Stress Management: Stress exacerbates symptoms of psoriatic arthritis. Engaging in stress management activities such as meditation, deep breathing, and mindfulness techniques can help manage stress levels.
   • Optimize Sleep Hygiene: Good sleep habits such as maintaining a regular sleep schedule and creating a comfortable sleep environment can be helpful in contributing to better rest and reduced early morning stiffness.
   • Balanced Nutrition: A diet that is rich in anti-inflammatory foods such as fruits and vegetables, whole grains, and omega-3 fatty acids can be helpful in reducing inflammation and the symptoms associated with it.⁽¹²⁾ Vitamin D in large doses can also be helpful in boosting the immune system without causing serious side effects.⁽¹³⁾
   • Using Assistive Devices: Using assistive devices can be helpful in providing support to the affected joints, reducing strain, and minimizing stiffness.
   • Avoiding Prolonged Immobility: Taking breaks and moving and stretching during periods of inactivity can be helpful in preventing joints from getting overly stiff.
   • Consulting a Healthcare Provider: Communicating with a healthcare provider regularly is an important part of the management of psoriatic arthritis. They can adjust the treatment plan and provide necessary guidance on lifestyle modification.

   Completely preventing psoriatic arthritis is not possible, but with the help of the strategies joint mobility can be improved and the severity can be reduced. Surgery is suggested for people with severe joint damage.

4. Tips to Make Mornings Easier in Psoriatic Arthritis

   It may be difficult for people with psoriatic arthritis to avoid stiff joints in the morning. Following the below-mentioned steps can be helpful in easing morning stiffness. 

   • Stretch the body before getting out of the bed
   • Make sure to warm the clothes in the dryer before getting dressed
   • Take a warm shower
   • Wearing heated gloves can be helpful in soothing the joints in the hands
   • Sleeping in a heated blanket
   • Taking gentle morning walks

5. When to Speak with a Doctor

   According to the American Academy of Dermatologists, treatment is important for the management of the symptoms of psoriatic arthritis.⁽¹⁰⁾

   Anyone experiencing joint stiffness in the morning should consider speaking with a doctor, particularly if the symptoms are interfering with the ability to perform daily activities and mental health.

   Early diagnosis and management are important to protect the joints from structural damage and prevent further progression of the condition.

6. Conclusion

   Early morning stiffness in psoriatic arthritis is a multifaceted endeavor that requires a combination of medical intervention, lifestyle adjustment, and proactive self-care.

   With consistent medication management, regular exercise, and a balanced approach to nutrition, individuals can take proactive measures to mitigate the impact of the symptoms.

   Employing assistive devices and optimizing daily routines can further contribute to improved joint mobility and overall well-being.

   Seeking regular guidance from healthcare providers and maintaining open communication is important to ensure that the treatment plans are tailored to individual needs. This may also allow for timely adjustments when necessary.

   A holistic approach is needed for psoriatic arthritis management and enhancing the quality of life.

Also Read:

• Psoriatic Arthritis: Types, Causes, Symptoms, Treatment- Analgesics, DMARDs, Surgery
• Elbow Psoriatic Arthritis: Types, Causes, Symptoms, Treatment, Prognosis, FAQ
• How is Psoriatic Arthritis Connected with Psoriasis?
• Psoriatic Arthritis Mutilans: Causes, Symptoms, Diagnosis, Risk Factors, Treatment, Prognosis
• Classifying Psoriatic Arthritis Based on Subtypes and Stages
• Injectable Treatments for Psoriatic Arthritis: Frequency, Monitoring & Risks
• 8 Useful Tips to Sleep Better With Psoriatic Arthritis