1.What is morning stiffness? Early one morning in the cold and damp, 38-year-old Ms. Zhang woke up and felt how the joints of her hands, which were originally dexterous and active, became inflexible, tense and stiff, looking awkward, but her hands moved for a while to ease the improvement. At first, she thought it was due to the cold and damp, and did not care. But then this feeling has been with her, and sometimes the joints are swollen and painful. Later, the symptoms gradually worsened, not only affect the household chores, even dressing also struggled. She had no choice but to go to the doctor. She was diagnosed with rheumatoid arthritis after taking films and laboratory tests. The doctor told her that the phenomenon of joint tightness, stiffness and immobility in the morning is called “morning stiffness” in medical science. 2.Why does morning stiffness occur? Morning stiffness often occurs when you wake up in the morning and feel stiffness in the affected joints and the surrounding muscles, inflexibility, inability to clench your fist, and even difficulty in buttoning your coat, combing your hair, brushing your teeth, etc. The stiffness and tightness can be reduced or relieved only after you move slowly. Morning stiffness is not necessarily limited to joints such as fingers and toes, but may also occur in all joints of the body such as knees, elbows, shoulders, neck and lower back. Morning stiffness may occur unilaterally or bilaterally, or it may be wandering, not fixed in one joint, but moving from one joint to other joints. The correct method of calculating the duration of morning stiffness should be calculated from the time when the stiffness appears after the patient wakes up to the time when the stiffness starts to decrease, usually in minutes. 3. Is morning stiffness an early sign of rheumatoid arthritis? In daily life, morning stiffness is often misdiagnosed as a result of cold, dampness, improper sleeping posture, etc., but it is not. Because morning stiffness is not related to these, it is usually a sign of the disease, especially one of the important early symptoms and diagnostic basis of rheumatoid arthritis. 4. What are the pathological characteristics of morning stiffness? Morning stiffness is a non-specific manifestation of inflammation. The basic pathological changes of rheumatoid arthritis are synovitis and vasculitis. In synovitis, the synovial membrane and joint capsule become congested, edematous, thickened, and roughened, and granulation tissue forms, resulting in impaired intra-articular circulation. Vasculitis of the tissues surrounding the joint causes narrowing of the vascular diameters, resulting in poor extra-articular circulation. When moving, blood and lymph can still flow normally, but long periods of immobility are prone to stagnation. 5. What are the causes of morning stiffness? The cause of morning stiffness lies in the accumulation of edema fluid in the inflammatory tissues during sleep or reduced exercise, which causes swelling of the tissues around the joint. After the patient moves, as the muscles contract, the edema fluid is absorbed by the lymphatic vessels and small veins, and the morning stiffness is relieved. The occurrence of morning stiffness may also be related to delayed secretion of adrenocorticotropic hormones, increased mucopolysaccharides in the collagen matrix, and increased viscosity of synovial fluid. Therefore, joint stiffness can also occur during the day as long as the affected joint activity is reduced or maintained in the same position for a longer period of time. 6. Is morning stiffness an important indicator of rheumatoid arthritis? Morning stiffness occurs in patients with rheumatoid arthritis in the acute or active phase of the disease, and its duration is proportional to the severity of synovitis. In severe cases, the stiffness may persist “all day” while awake, although this persistent stiffness is strictly speaking much more than morning stiffness; when the disease improves, the duration of morning stiffness is shortened or reduced, and when the disease is in remission, it may disappear completely. Morning stiffness is one of the important indicators to observe and determine the severity of the disease. Generally, the duration of morning stiffness over 30 minutes has clinical significance. According to research, patients with rheumatoid arthritis in Western countries have longer morning stiffness than those in the East. In the American College of Rheumatology rheumatoid arthritis diagnostic criteria, there is a mention of morning stiffness to more than 1 hour. 7. How is morning stiffness classified? Morning stiffness can be classified into three degrees according to the degree of joint and body stiffness and the time to relieve or disappear after activities: (1) Mild: Several finger joints, wrist and toe joints occur at the same time when waking up or waking up after a few minutes, tens of minutes to an hour of activities, the stiffness of the joint is relieved or disappears. (2) Moderate: More than four small joints or one to two large joints are involved at the same time, and the stiffness is relieved or disappears after 1 to 6 hours of activity or until noon (half a day) after waking up or waking up. (3) Severe: More than seven or more joints of the whole body are involved at the same time, and the stiffness of the joints and the whole body is not significantly relieved after getting up or waking up, and it often lasts for more than 6 to 12 hours or the whole day, and medication must be taken to relieve or reduce it. 8.Does morning stiffness necessarily mean that you are ill? It must be pointed out that although morning stiffness is a sign of certain diseases, it is not necessarily a disease, because there is a difference between physiological and pathological morning stiffness, and physiological morning stiffness should be distinguished from pathological ones. For example, mild morning stiffness in the elderly is a normal physiological phenomenon, usually shorter than 15 minutes, and the degree is also light, and easy to relieve, without any treatment, so there is no need to be nervous and afraid. If the morning stiffness lasts for a long time (more than 30 minutes) or is accompanied by joint swelling and pain, it has clinical significance and suggests pathology and the existence of underlying diseases. 9.Is morning stiffness the “patent” of rheumatoid arthritis? Morning stiffness is not the “patent” of rheumatoid arthritis. It can be found in other types of inflammatory arthritis, such as systemic lupus erythematosus, rheumatoid myofibrositis, osteoarthritis, dermatomyositis, ankylosing spondylitis, psoriatic arthritis, reactive arthritis, etc. Morning stiffness can occur. Therefore, only the symptoms of morning stiffness can not clearly diagnose which disease it is, but a comprehensive judgment of clinical manifestations, combined with blood sedimentation, anti-“O”, rheumatoid factor, autoantibodies and other laboratory tests, can confirm the diagnosis.