Morning stiffness does not exclude hand osteoarthritis: study

Prolonged morning stiffness of more than 60 min can be present in patients with hand osteoarthritis despite the symptom being more established in inflammatory arthritis and RA in particular.

Data from 538 patients in the Hand OSTeoArthritis in Secondary care (HOSTAS) study found morning stiffness was present in 87% of patients. The cohort were mostly women (86%) with a mean age of 61 years. The study excluded participants with hand symptoms due to conditions such as RA, psoriasis and secondary OA.

Almost half the patients (46%) reported morning stiffness duration lasted for <30 mins, 24% for 30-60 mins and 17% for >60 mins. Stiffness severity was reported as mild (30%), intermediate (37%), severe (18%) and extreme (4%).

The study, published in Osteoarthritis & Cartilage [link here], found patients with prolonged morning stiffness >60 mins had more radiographic damage and erosive disease than other patients, although the differences did not reach statistical significance.

“Patients with prolonged morning stiffness reported significantly more pain, had worse physical function and had significantly lower physical and mental quality of life as compared with patients without prolonged morning stiffness,” the study said.

“Our study is the first to show that prolonged morning stiffness in patients with hand OA is associated with a lower health-related quality of life, independent of pain. It is therefore important to assess stiffness in patient care and clinical trials, because it could be a potential target for interventions such as physical therapy.”

Of the patients with prolonged morning stiffness, one was diagnosed with RA during follow-up after 28 months.

The study noted it can be difficult for patients to describe the phenomenon of morning stiffness and define its duration.

“The simple question whether morning stiffness is present and what its duration is, might therefore be insufficient to discriminate between morning stiffness that is inflammatory in character and morning stiffness that is not.”

“The latter may have a more structural aetiology such as bone and/or soft tissue deformity, although we could not find a significant association with radiographic severity.”

The investigators said that prolonged morning stiffness as defined by standardised questionnaires does not preclude a diagnosis of hand OA.

“A more thorough interviewing technique such as used by most physicians in daily practice might be more discriminative, however this is a very speculative hypothesis that needs further study.”

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