Is Morning Stiffness Important? Save

Morning stiffness? An oft-asked question, but does it have reliable discriminatory value? While this was once the hallmark feature of inflammatory arthritis and has been included as a rheumatoid arthritis criteria back to the days of Steinbrocker, it is no longer apart of the ACR/EULAR criteria for RA.

European investigators analyzed several early arthritis cohorts (EARC, REACH, Leiden EAC, ESPOIR) and found morning stiffness (≥ 60 minutes) was associated with the presence of synovitis with odds ratio ranging from 1.49 - 2.21. Yet the sensitivity ranged from 13-54% and the specificity from 48-91%. The authors conclude that "the duration of morning stiffness of 30 minutes had the best combination of sensitivity and specificity (74 to 77% and 48 to 52% respectively). However, in case one prefers to be specific (specificity ≥ 80%) a cutoff duration of 60 minutes is preferable." Morning stiffness was not associated with radiological progression or DMARD-free sustained remission.