Is Morning Stiffness Associated with Disease Activity in the Patients with Rheumatoid Arthritis?

Abstract

Objective: Rheumatoid arthritis (RA) is a systemic autoimmune disease characterized by chronic joint inflammation and destruction. Morning stiffness is included in classification criteria, remission criteria and inclusion criteria for most clinical trials in RA. The aim of the present study was to estimate possible associations between morning stiffness and laboratory and clinical parameters in patients with RA. Material and methods: A total of 114 patients with RA (F/M: 89/25, mean age 51.41±12.91 years) were included in the study. Duration of morning stiffness was evaluated, and a stiffness lasting more than one hour was accepted as morning stiffness according to ACR criteria. Functional disability was assessed according to Health Assessment Questionnaire (HAQ) and disease activity was assessed with 28-joint disease activity score (DAS-28). Laboratory evaluation included erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and rheumatoid factor (RF). Results: Sixty patients (52.6%) reported morning stiffness more than one hour. Eighty six (75.5%) patients had RF positivity. There was no significant difference between the groups with and without morning stiffness regarding age, disease duration, and age at onset of the symptoms (p>0.05). Although ESR, CRP, DAS-28 and HAQ scores were higher in the RA patients with morning stiffness (p<0.05), a significant correlation was not found between the duration of morning stiffness and these parameters (p>0.05). Furthermore, there was no significant association between morning stiffness and the presence of RF positivity (p>0.05). Conclusion: The present study revealed that a morning stiffness lasting more than one hour was important in the evaluation of disease activity in RA whereas the duration was not associated with the activity parameters. Copyright © 2008 by Turk Tibbi Rehabilitasyon Kurumu Derneǧi.