Inflammation and Stiffness

Learning about these symptoms can help you get the right diagnosis. By Greg Freeman (Published by The Arthritis Foundation)

As a disease, arthritis is more complicated and varied than most people imagine. It can come in different forms and affect people in different ways. But the common thread through most forms of arthritis? Inflammation and stiffness of the joints.

Swelling may occur for two key reasons. Either the lining of the joint, known as the synovium, swells (synovitis) or the synovial fluid increases in volume (an effusion). It is an active process: inflammatory cells (mainly white cells) and more blood enter the joint, while many inflammatory molecules, such as small proteins (peptides) are released into the soft tissues around the joint. The increased blood flow makes the joint swell and feel warm. The inflammatory materials cause joint fluid to collect in and around the joint, which adds to the swelling. The type of joint swelling can vary depending on the type of arthritis you have.

Inflamed joints can feel especially stiff first thing in the morning. How long it lasts is important: an hour or more is suggestive of inflammatory arthritis. Defining morning stiffness is hard, although people with arthritis describe it as an ache combined with difficulty moving. Stiffness following exercise is usually a feature of osteoarthritis; it is a sign that the joints are starting to fail. People also feel stiff when they rest, such as sitting down after a walk or relaxing in the evening. The joints are sometimes said to “gel,” a term reminiscent of how gelatin sets – a gradual process of firming up. Joint stiffness may occur with or without joint pain. Stiffness can affect any joint– the fingers and hands, wrists, elbows, knees, ankles, feet, shoulders, hips, and even the jaw.

Know Your Symptoms

Other signs and symptoms in addition to the inflammation and stiffness will help your doctor figure out what kind of arthritis you have.

In RA, the immune system attacks the lining of the joint becomes inflamed, leading to the stiffness, pain, warmth, redness, and swelling around the joint. Then the disease leads to rapid division and growth of cells, which causes the synovium to thicken. Later the inflamed cells release enzymes that may digest bone and cartilage, causing joint erosion. The swelling, warmth and stiffness that accompany RA can last for hours. It can affect any joint, but usually starts in small joints (like those in the hands or feet) and occurs on both sides of the body. Joint stiffness is usually worst in the morning. Other symptoms such as pain or fatigue tend to develop and worsen over several weeks or months.

OA usually occurs due to wear and tear, injury or both. The most commonly affected joints are the lower back, hips, knees and feet. Although inflammation is not a main symptom of osteoarthritis, it can occur in the joint lining in response to the cartilage breakdown. Morning stiffness may be severe but is usually brief – less than 30 minutes – that occurs after waking up in the morning or a period of rest. Joint redness, warmth and swelling are usually minimal.

In psoriatic arthritis, joint pain is usually associated with swelling and redness in the knees, ankles, fingers, and toes. Some people with psoriatic arthritis also have neck and/or back pain, along with stiffness that can limit movement. The disease can also include swelling of fingers and/or toes that gives them a “sausage-like” appearance. Silver or gray dry, scaly spots on the scalp, elbows, knees and/or the lower end of the backbone with flaking skin can be associated with PA, as can small depressions in the fingernails and/or toenails, and/or detachment of nails.

In an arthritis-related disease called systemic lupus erythematosus (SLE, or commonly called lupus), the immune system attacks itself causing swelling and pain. Most individuals with lupus have rashes, swollen joints, fever and feel fatigued. Sometimes weight loss and hair loss in spots or around the hairline occurs.

Do You Have Arthritis?

How do you know if your inflammation and stiffness means you have arthritis? Only a health care professional can tell you for sure, but certain signs usually point to arthritis. There are four important warning signs that should prompt you to talk to a health care provider.

  • Pain. Pain from arthritis can be constant or it may come and go. It may occur when at rest or while moving. Pain may be in one part of the body or in many different parts.
  • Swelling. Some types of arthritis cause the skin over the affected joint to become red and swollen, feeling warm to the touch. Swelling that lasts for three days or longer or occurs more than three times a month should prompt a visit to the doctor.
  • Stiffness. This is a classic arthritis symptom, especially when waking up in the morning or after sitting at a desk or riding in a car for a long time. Morning stiffness that lasts longer than an hour is good reason to suspect arthritis.
  • Difficulty moving a joint. It shouldn’t be that hard or painful to get up from your favorite chair.

Your experience with inflammation and stiffness will be important in helping your doctor pin down the type and extent of arthritis. Before visiting the doctor, keep track of your symptoms for a few weeks, noting what is swollen and stiff, when, for how long, and what helps ease the symptoms.

If the doctor suspects arthritis, he will perform tests to check the range of motion in your joints, asking you to move the joint back and forth. The doctor may also check passive range of motion by moving the joint for you. Any pain during a range of motion test is a possible symptom of arthritis.

Treating inflammation and stiffness can involve medicine, both prescription or over-the-counter, and other methods. Follow your doctor’s instructions, but here is some general advice:

No medicine required

Applying heat or cold to affected joints is one of the easiest ways to relieve arthritis pain and stiffness on a short-term basis. Heat relaxes muscles and increases circulation in specific areas. Some examples of heat are hot packs, heating pads, heated pools, and warm showers.

Cold reduces swelling and numbs the nerves that detect pain. Some examples of cold are ice packs or cold packs such as frozen vegetables.

You can decide whether warm or cold works best for you by trying them both. Do what is most comfortable because your comfort plays an important role in keeping your pain at a low level.

Neither heat nor cold should be applied for more than 20 minutes, and skin should be allowed to return to its normal temperature between applications. It’s also always a good idea to cover the object you’re using with a towel to help protect your skin.

Over-the-Counter Medicines

Acetaminophen is an aspirin-free pain reliever. It helps reduce pain but has little effect on inflammation. Many healthcare providers consider aspirin-free pain relievers the preferred first choice in treating mild to moderate arthritis.

Another type of oral medication is non-steroidal anti-inflammatory drugs (NSAIDS). These help reduce both pain and joint swelling. NSAIDS may cause stomach problems and other complications. Some are available only by prescription. Some examples are: Aspirin, ibuprofen and naproxen sodium.