Pain first thing in the morning is a tough way to start your day, but you can make it better.
Everyone can feel a bit tight in the morning now and then, but a few stretches as you climb out of bed usually solve the problem when it’s garden-variety stiffness. The joint pain and stiffness associated with rheumatoid arthritis, however, is on another level. It may last for hours and can really impair your ability to rush through your morning routine—so racing to style your hair with a curling iron, button up a delicate sweater, and pack the kids’ school lunches and snacks before catching the bus for work is probably going to be a challenge.
Here’s why your joint pain is worse in the morning when you have RA: The symptoms of rheumatoid arthritis stem from inflammation from the immune system. “The immune system has natural circadian rhythms, so it tends to be more active during the middle of the night and early morning,” says Ashira Blazer, MD, rheumatologist at NYU Langone Medical Center. A more active immune system means a more aggressive inflammatory response.
The joint cavities contain a lubrication called synovial fluid, which reduces friction between bones as they move. For someone with RA, inflammatory cells and proteins settle into that synovial fluid overnight, which causes increased pain and stiffness during the morning, according to Dr. Blazer.
“Anything that you might do in the morning would take a little longer if you have [RA],” says Dr. Blazer. “Anything that requires repetitive motion and engagement of the joints may take longer than you expect.”
In general, following lifestyle habits that reduce inflammation may help ease your joint pain in the morning, but one in six patients in RA remission or with low disease activity still experiences morning pain from RA, according to a 2011 study. If stiffness continues to plague your morning routine, here are five ways to outsmart it.
1. Off-load your morning tasks.
Move more aspects of your morning routine to the night before. Activities like prepping meals for the family might fit better in your evening routine, when your joints are a bit less hindered. Selecting your clothes for the next day, prepping an easy breakfast (like this pumpkin seed granola), and organizing your bag or briefcase in the evening can minimize stress on the joints in the morning.
Bonus: Shifting some of these activities to your evening may cut down on morning chaos and improve your organization. Here are more tips for your evening routine to reduce stress.
2. Take meds first thing in the morning.
“For one, it’s easier to remember,” says Dr. Blazer. But the benefit goes beyond logistics: “You’re taking the medication to reduce inflammation at the time that you’re having most of your symptoms.”
3. Get some gentle exercise.
It’s counterintuitive, but exercise often alleviates RA joint pain, according to the Arthritis Foundation. That doesn’t mean you need to find a 6 A.M. kickboxing or Spin class, though.
Low-impact workouts, like yoga and tai chi, are ideal for exercising inflamed joints. Yoga promotes both strength and flexibility, according to Dr. Blazer. This can help prevent muscle loss and reduced range of motion from RA.
Yoga and tai chi have benefits that go beyond the physical body. “[Tai chi] is something that helps not only balance the muscles but also balance the mind, almost like meditation,” says Dr. Blazer. “It helps patients cope with the pain of [RA].” (Learn more alternative ways to meditate to reduce stress.)
Other low-impact exercises to do in the morning include a basic stretching routine, walking, or swimming, according to the Arthritis Foundation.
4. Take a hot shower.
Many people with RA find relief from their morning joint pain using warming techniques. If you’ve always been loyal to evening showers, you may want to give an A.M. shower another shot: A warm shower first thing in the morning can loosen up those joints and reduce pain and inflammation.
And of course, heat from hot water bottles, electric blankets, or warm wash cloths can soothe pain at any time of day, according to the Arthritis Foundation.
5. Give yourself a break.
If you’re the type of person who holds yourself to unreasonably high standards (and who doesn’t?), you may be hard on yourself for moving so, so slowly in the morning or struggling with simple tasks. Don’t.
“I think we all put tons of pressure on ourselves, and it’s very frustrating to want to do more and know that you can do more, and then your body won’t do it,” says Dr. Blazer. “Sometimes it’s okay to off-load, to delegate, and to let other people take care of you.” In other words, asking for help does not make you weak.
For more tips on managing RA symptoms, here are tips for living with rheumatoid arthritis from Michael Kuluva, a fashion designer and patient coping with RA.
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the mornings can be particularly challenging times.
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The immune system has natural circadium rhythms
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so it tends to be more active in the middle of the night
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and early morning, and a lot of the inflammatory cells
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and proteins have settled out in the joint fluid
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called synovial fluid in the morning time.
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So patients tend to wake up with tons of stiffness,
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tons of swelling, and have some difficulty getting going.
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So anything that you might do in the morning
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would take a little longer if you have Rheumatoid Arthritis.
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If you can imagine trying to put on your makeup,
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or even brushing your hair,
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anything that requires repetitive motion
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and engagement of the joints
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may take longer than you expect.
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The first word of advice is to off-load
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tasks from the morning.
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So if you need to make lunches for school,
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make them at night, store 'em in the fridge,
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and that way you can just hand them off in the morning.
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Pick your outfits for the day in the night time
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or in the afternoon instead of putting
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that task in the morning.
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I tend to recommend that patients take their
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medications first thing in the morning.
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For one, it's easier to remember.
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As well, you're taking the medication to reduce
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inflammation at the time that you're
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having most of your symptoms.
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I'd also say in the morning time,
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a lot of patients will improve with some movement.
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So I actually recommend yoga often to my patients
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for one, because it promotes strength
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and also flexibility.
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So it helps with a nice balance in supporting the joints.
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Also, Tai Chi is very low impact.
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It's something you can do at home
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and it's something that helps not only balance the muscles,
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but also balance the mind.
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Almost like meditation and it helps patients
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cope with the pain of Rheumatoid Arthritis.
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Usually patients who have Rheumatoid Arthritis will say,
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if I wake up in the morning and I'm stiff,
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I take a hot shower, and the warm water from the shower
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will help to loosen my joints and make them feel better.
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But I think the number one word of advice
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is just to give yourself a little break.
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I think we all put tons of pressure on ourselves
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and it's very frustrating to want to do more,
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and know that you can do more,
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and then your body won't do it.
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Just understanding that sometimes it's okay
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to off-load, to delegate, and to let other people
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take care of you, just improves your life in general.
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Best exercises for rheumatoid arthritis. Atlanta, GA: Arthritis Foundation. (Accessed on April 4, 2018 at https://www.arthritis.org/about-arthritis/types/rheumatoid-arthritis/articles/best-exercises-for-ra.php.)
Rheumatoid arthritis vs. osteoarthritis. Rheumatoid Arthritis Support Network, 2016. (Accessed on April 4 2018 at https://www.rheumatoidarthritis.org/ra/ra-vs-oa/.)
Sierakowsi S, Cutolo M. Morning symptoms in rheumatoid arthritis: a defining characteristic and marker of active disease. Scand J Rheumatol Suppl. 2011;125:1-5.
Warming techniques to relieve rheumatoid arthritis pain. Atlanta, GA: Arthritis Foundation. (Accessed on April 4, 2018 at https://www.arthritis.org/living-with-arthritis/pain-management/tips/warming-techniques-rheumatoid-arthritis-pain.php.)