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New Research on Morning Stiffness

Recent research reveals a chemical reason for morning stiffness. Apparently, an anti-inflammatory protein works in our body at night while we sleep and wears off in the morning. The researchers think this helps explain why people with rheumatoid arthritis have more stiffness during the day.

Although this finding doesn’t help immediately with new RA drugs, a co-author thinks this knowledge could help with timing medications so that they are more active during the day when patients may be experiencing the strongest symptoms.

My first thought was that I should sleep more! Only half-kidding about that. If the biochemical works while I am sleeping, perhaps that explains why I feel better during sleep and enjoy it so much. (Except at times when I am too achy to sleep well at all.) But the research does make me wonder if this chemical reaction could be harnessed for use during the daytime as a possible RA treatment.

Additionally, I need to learn more about my medications and timing them to be active when I most need them. One of my previous rheumatologists told me to always take my prednisone first thing in the morning because it is a relatively fast-acting drug and would help me through the day.

But what about my other medications? Would changing the timing of my dosage improve their effectiveness in addressing my symptoms during daytime hours when I am either at work or active? I will need to have more of a discussion with my doctor to ask and perhaps even try some experimenting.

One thing I do know is that I need more sleep or just plain rest than people without RA. Perhaps this chemical reaction is a part of the fatigue cycle or plays into how people with RA need sleep? Our bodies could be telling us that we need more of this protein for bringing down our RA inflammation.

I admit that I also often wonder if my sleep is as restful as others because I frequently feel tired even after a full, long night of rest. In my opinion, the many complexities of the relationships between fatigue, sleep, and rheumatoid arthritis have been barely explored and there exists a great deal of opportunity for research.

Someplace else I read that there is a disconnect between how people with RA experience fatigue and the activity of their disease. Sometimes the two will be correlated, but not always. I can identify with both experiences. But I also feel that doctors may not always pay as much attention as they should to fatigue and sleep for people with RA. This should be a top question they ask and track, not just pain, stiffness, and blood tests.

In my case, if I had better listened to my body about increases in fatigue, I would have detected flare-ups earlier and had treatment for them. Instead, I hesitated to believe that I was more exhausted and delayed talking to my doctor, which delayed addressing my RA flare. This was my responsibility, but also a broader failure to not pay attention to the issues of fatigue.

In any case, this new study highlights a previously unknown benefit of rest for people with rheumatoid arthritis and suggests more avenues of research for developing treatments and timing medications to best support us throughout the day.

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.


  • DCSharon
    1 year ago

    Not sure if this issue is related to morning stiffness, but I’ve been reading a lot about inflammatory cytokines, which have been correlated with fatigue. The latest medications, such as biologics and Zeljanz, target the cytokine receptors. Cytokines are the same components produced in the body when there is infection, promoting “sickness behavior” (fatigue, malaise, insomnia, body aches, lack of appetite, apathy, depression). I think anyone with RA can say they feel sick in the middle of a flare!

  • Kelly Mack moderator author
    1 year ago

    Hi DCSharon, very interesting! I had not heard about inflammatory cytokines being related to fatigue. Hopefully this means new drugs will help to target that pesky fatigue problem. Best, Kelly ( Team Member)

  • Mary Sophia Hawks moderator
    1 year ago

    Great information, Kelly! This makes so much sense. As for the extreme fatigue being a precursor to a flare, I think you are on target. My last flare reared it ugly head after a week of disabling fatigue. I got lots of rest, hoping to head it off, but it didn’t work. We RA folks all live with a certain amount of fatigue every day (thank goodness for coffee), but when it cripples us we need to pay attention. I dealt with crushing fatigue for 1 1/2 years, until we stopped my methotrexate. It’s an ongoing battle to figure out which medication will help, and how much fatigue is “bearable”.
    I agree with you that timing of medications is essential. I currently take Xeljanz. I tried the XR version, but felt worse as the day went on. I went back to the twice a day version and have been more successful.
    I really enjoy your articles! You have a gift and I appreciate you.


  • Kelly Mack moderator author
    1 year ago

    Thanks so much c7mv96–your words have totally made my day. 🙂 Really glad that my articles are helpful. All the best, Kelly ( Team Member)

  • Monica Y. Sengupta moderator
    1 year ago

    Hey MS (@c7mv96)! Thank you so much for your lovely words!

    I went through something similar where I had to trial and error my medications to see what reduced the fatigue the most. Like you, MTX tends to make me for fatigued but after a little playing we (my doctor and I) found that just lowering the dose by just 0.1cc made a world of difference.

    I wrote an article on how I manage (or work around) my fatigue. I thought you might enjoy it!

    How do you manage yours? Do you have any special activities when you just have to rest through the tiredness? Thanks again for the kind comment! ~Monica

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