Morning joint stiffness: what is normal and what suggests inflammatory arthritis

After a night's rest, most joints feel a little stiff. What distinguishes mechanical wear from inflammation is how long it takes to loosen up. The NHS rheumatoid arthritis symptoms page says the stiffness of osteoarthritis usually wears off within 30 minutes of getting up, whereas morning stiffness in rheumatoid arthritis often lasts longer than this. The NHS polymyalgia rheumatica page uses a threshold of longer than 45 minutes.

Duration is a clue, not a diagnosis. Doctors combine it with which joints are affected, whether the pattern is symmetrical, the person's age, swelling, general symptoms and blood tests.

The NHS describes osteoarthritis as the most common type of arthritis in the UK, causing painful, stiff joints that most often affect the knees, hips and small joints of the hands. A GP may suspect it if you are 45 or older, have joint pain that gets worse the more you use the joints, and stiffness that is absent in the morning or lasts less than 30 minutes. X-rays or blood tests are not usually necessary, but may be used to rule out other causes.

Osteoarthritis is long term and cannot be cured, but the NHS says it does not necessarily get worse and can sometimes gradually improve. Simple measures include regular exercise, losing weight if overweight and suitable footwear.

The NHS says rheumatoid arthritis is an autoimmune disease in which the immune system attacks the lining of the joints, causing swelling, stiffness and pain. Symptoms often develop gradually over several weeks but sometimes progress over days. The small joints of the hands and feet are often the first affected, typically on both sides of the body. Pain is usually throbbing and aching and often worse in the mornings and after inactivity, and affected joints can feel hot and tender. General symptoms include tiredness, a high temperature, sweating, poor appetite and weight loss.

The NHS says to see a GP if you think you have symptoms, because early diagnosis and treatment can prevent it getting worse and reduce the risk of joint damage. There is no cure, but early treatment lets many people have months or years between flares.

Polymyalgia rheumatica causes pain, stiffness and inflammation in the muscles around the shoulders, neck and hips. The NHS says its main symptom is morning stiffness lasting longer than 45 minutes, with possible extreme tiredness, loss of appetite, weight loss and depression. It is age-related, with most people over 65 and it is very rare under 50, more common in women. Treatment is usually a steroid, prednisolone, started at a moderate dose and gradually reduced, with most people needing 12 months to 2 years.

Up to 1 in 5 people with polymyalgia develop giant cell arteritis (temporal arteritis). The NHS says a new or frequent headache that usually develops suddenly, scalp tenderness, jaw or tongue pain when eating or talking, or sight problems such as double vision or loss of vision need immediate medical attention, via a GP, NHS 111 or emergency services, because it can lead to stroke or blindness.

Persistent back stiffness that eases with movement, particularly in a teenager or young adult, can be ankylosing spondylitis, which the NHS says tends to first develop in teenagers and young adults, with back pain and stiffness developing gradually over months or years. Other causes of stiffness include psoriatic arthritis, thyroid problems and prolonged inactivity. A GP can arrange blood tests and refer to a rheumatologist when inflammatory arthritis is suspected.

Note how long stiffness lasts each morning, which joints are affected, whether both sides are involved, swelling or warmth, and general symptoms such as fatigue, fever or weight loss. Keep gently active, since movement tends to ease stiffness. See a GP if stiffness lasts more than a week with pain, if joints are swollen and hot, or if the pattern is new. Do not delay if you have the head and eye warning symptoms described above.