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Causes of Morning Stiffness

Reviewed by Brunilda Nazario, MD on November 18, 2020

It’s easy to blame aging, an old mattress, or a poor night’s rest when you wake up feeling stiff and achy. It's true that those things can make you feel stiff in the morning. But if it happens a lot, it might be a sign of a medical condition.

Morning stiffness is a symptom of several types of arthritis, including osteoarthritis (OA), the common type many people get as they age. It's also a warning sign of inflammatory types of arthritis such as:

It’s not surprising that aging and OA cause morning stiffness. Age causes the cartilage that cushions your joints to dry out. And your joints make less of the synovial fluid that adds lubrication, causing you to feel stiff and sore. This is sometimes called “morning gel,” because your joints stiffen like gelatin when you're inactive for several hours.

When you have RA, PsA, or AS, inflammation is what triggers your morning stiffness.

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The biggest difference between morning stiffness in people with OA and those with inflammatory arthritis is how long it lasts. For those with osteoarthritis, the stiffness often lasts just a few minutes and eases once you start moving. If you have inflammatory arthritis, it may take an hour or longer to go away.

Morning stiffness is the most common symptom of ankylosing spondylitis, which mainly affects the spine, hips, and knees. With AS, you most often have stiffness in your low back and neck.

As with RA and OA, long periods of rest -- like 8 hours of sleep -- make stiffness worse for people with AS. But it eases with a hot shower or light exercise.

Other health conditions that can cause morning stiffness include:

If you wake up feeling seriously stiff and sore for more than 3 days in a row, make an appointment with your doctor.

Your doctor may check your joints, run bloodwork, or test your joint fluid to check for inflammation. The results will help determine the cause of morning stiffness and help your doctor figure out how to treat you.

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If you have OA, you might take over-the-counter pain medication.

If inflammatory arthritis is to blame, your doctor will likely prescribe an anti-inflammatory drug. A class of medications called biologics have been shown to reduce morning stiffness and decrease pain, swelling, and fatigue.

Whatever the cause of your morning stiffness, your doctor may also suggest:

No one wants to start the day feeling stiff and sore. Finding out the cause of your stiffness and establishing a treatment plan can help you wake up ready to start the day.

WebMD Medical Reference

Sources

SOURCES:

Harvard Medical School: "What makes my joints stiff in the morning?"

Hospital for Special Surgery: “Ankylosing Spondylitis: An Overview.”

Arthritis Research & Therapy: “Reappraisal of the diagnostic and prognostic value of morning stiffness in arthralgia and early arthritis: results from the Groningen EARC, Leiden EARC, ESPOIR, Leiden EAC and REACH.”

Current Medical Research and Opinion: “Economic burden of fatigue or morning stiffness among patients with rheumatoid arthritis: a retrospective analysis from real-world data.”

Cleveland Clinic: "Waking Up Stiff? How 'Morning Gel' Can Affect Your Joints + Tips for Relief."

Spondylitis Association of America: “Most Common Symptoms.”

Arthritis Foundation: “When It’s Time to See a Doctor for Joint Pain.”

Institute for Quality and Efficiency in Healthcare: “Rheumatoid arthritis: Medication to prevent joint damage.”

Complementary Therapies in Clinical Practice: “A 12-week Baduanjin Qigong exercise improves symptoms of ankylosing spondylitis: A randomized controlled trial.”

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