In general, inflammatory arthritides tend to be worse at night and in the morning. For example, the morning stiffness associated with rheumatoid arthritis is classically worse in the morning. This is also true of many other inflammatory conditions that cause arthritis (e.g. psoriatic arthritis, lupus, ankylosing spondylitis, etc.)

What makes the joint symptoms worse at night and in the morning? Is this related to mechanical factors (i.e. inactivity of the involved joints at night) - and if so why would that lead to worsening of symptoms? Or is it due to a circadian rhythm in systemic pro- and anti-inflammatory mediators (e.g. cytokines, cortisol, other hormones)? Or some other factors?

I could not find much to address this question. Further references are also appreciated.

  • short answer, no one really knows. medscape.com/viewarticle/846218 But it can't all be due to cytokines and cortisol since RA patients also experience gelling during the day. – Graham Chiu May 18 '16 at 4:21
  • This is an interesting article: ard.bmj.com/content/67/7/905.full.pdf - might be sufficient to draft an answer when I get to it – user2398029 May 20 '16 at 3:45
  • I have a reactive arthritis and it is the other way around for me. I feel great in the morning, but after a long day with lots of walking, standing, sitting etc. my feet get swollen and hot. So, basically resting, elevating and ice calm my inflammation and swelling. Especially sleeping is great. – user10321 Oct 21 '16 at 1:18

Although the etiology is unknown, we have a bit of an idea of its pathophysiology

Etiology of RA is unknown. Although the impact of genetic factors is obvious, the genetic basis is not sufficient to explain the triggering of the immune insult. - pubmed - ncbi

As you have mentioned, the circadian rhythm of cytokines has something to do with the classical pattern of "morning stiffness".

...inflammatory cytokines, which reach peak secretion early in the morning are major players causing the morning stiffness - PMC - ncbi

The claim of pain relief with joint movement/activity is yet to be explained but there is a study wherein exercise in patients with rheumatoid arthritis is beneficial in terms of muscle strength improvement. (Benefits of Exercise in Rheumatoid Arthritis -ncbi)

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