Stiffness is more than just duration and severity: a qualitative exploration in people with rheumatoid arthritis

Abstract

Objective. Stiffness is internationally recognized as an important indicator of inflammatory activity in RA but is poorly understood and difficult to measure. The aim of this study was to explore the experience of stiffness from the patient perspective.Methods. Semi-structured interviews conducted with 16 RA patients were analysed independently by researchers and pat.ient partners using inductive thematic analysis.Results. Six themes were identified. Part of having RA identified stiffness as a normal consequence of RA, perceived as associated with disease-related aspects such as fluctuating disease activity, other RA symptoms and disease duration. Local and widespread highlighted stiffness occurring not only in joints, but also over the whole body, being more widespread during the morning or flare. Linked to behaviour and environment illustrated factors that influence stiffness, including movement, medications and weather. Highly variable captured the fluctuating nature of stiffness within and between patients and in relation to temporality, duration and intensity. Impacts on daily life emphasized the effect of stiffness on a range of domains, including physical function, quality of life, psychological well-being, activities of daily living and participation in work and leisure activities. Requires self-management detailed self-management strategies targeting both the symptom and its consequences.Conclusion. Patients’ experiences of stiffness were varied, complex and not exclusive to the morning period. Importantly, stiffness was reported in terms of impact rather than the traditional measurement concepts of severity or duration. Based on these findings, further research is needed to develop a patient-centred measure that adequately reflects inflammatory activity.

More than Just Minutes of Stiffness in the Morning: Report from the OMERACT Rheumatoid Arthritis Flare Group Stiffness Breakout Sessions

“…Two qualitative studies were conducted by members of our group to further explore the experience of stiffness in RA (10, 11). Similar themes were identified in both studies and incorporated into conceptual frameworks encompassing the heterogeneous experience of stiffness impact, intensity, timing, location and duration in people with RA.…”

“…The stiffness question, developed by the Flare Steering Committee, asked people to “Circle the number than best describes the stiffness you have felt due to your rheumatoid arthritis during the past week” (0-10 numeric rating scale where 0 = none and 10 = extreme). Two break-out groups were held to discuss these results and new qualitative studies conducted in the US and UK (10, 11) in relation to stiffness measurement.…”

“…The overall concept of stiffness in RA remains poorly defined. It is unclear whether assessing morning stiffness duration and intensity adequately reflects the heterogeneity of the construct (10, 11). …”

Feasibility and Domain Validation of Rheumatoid Arthritis (RA) Flare Core Domain Set: Report of the OMERACT 2014 RA Flare Group Plenary

“…Results from focus groups with 20 participants (USA; (23)) and 16 individual interviews (UK; (24)) were presented. Findings suggested that people with RA described the experience of stiffness in terms of severity and impact throughout the day, rather than as the duration of morning symptoms.…”

Observational Study of a Wearable Sensor and Smartphone Application Supporting Unsupervised Exercises to Assess Pain and Stiffness

“…Patients with arthritis frequently report symptoms such as morning pain and stiffness, leading to limitations at a functional level and impaired quality of life [1,[3][4][5]. It is therefore logical that therapeutic interventions for arthritis would specifically target this period of the day and that any evaluation of their efficacy would focus on their direct impact on morning pain and stiffness [6].…”