Joint Stiffness: Causes and Treatment

What joint stiffness feels like

Stiff joints feel tight, creaky or hard to bend, as if they need "oiling". You may not be able to make a full fist, straighten a knee or raise an arm overhead. Stiffness is usually worst after inactivity, such as on waking or after sitting, and loosens with gentle movement. This is sometimes called gelling.

Why stiffness duration matters

For more on stiffness on waking, see morning stiffness.

Common causes of stiff joints

Osteoarthritis

Osteoarthritis is the most common joint condition. Cartilage thins and bone edges thicken, producing stiffness after rest, pain with use, creaking (crepitus) and bony enlargement, especially in the knees, hips and hands.

Rheumatoid arthritis

Rheumatoid arthritis is an autoimmune disease that inflames the joint lining. It typically causes long morning stiffness, swollen, tender small joints in both hands and feet, and fatigue. Treatment within the first few months of symptoms reduces joint damage.

Other inflammatory arthritis

• Psoriatic arthritis: with psoriasis, nail pitting, swollen "sausage" fingers or toes.
• Ankylosing spondylitis: spine and sacroiliac stiffness.
• Lupus: joint pain and stiffness with rashes, mouth ulcers and fatigue.
• Reactive and viral arthritis: short-lived arthritis after infections such as parvovirus, chikungunya or gut infections.

Gout and pseudogout

Gout causes sudden, very painful attacks, most often in the big toe, with redness and swelling. Stiffness and aching can persist between attacks in chronic gout.

Polymyalgia rheumatica

Polymyalgia rheumatica causes severe stiffness and aching in the shoulders, neck and hips in people over 50, worst in the morning. It responds dramatically to low-dose steroids.

Frozen shoulder

Frozen shoulder (adhesive capsulitis) causes gradually increasing pain and stiffness, with marked loss of movement, especially rotation. It is more common in people with diabetes and usually recovers over 1 to 3 years.

Other causes

• Injury: sprains, fractures and post-traumatic arthritis.
• Inactivity and aging: muscles and connective tissue tighten.
• Hypothyroidism: joint stiffness and aches with fatigue, weight gain and feeling cold.
• Lyme disease: swelling and stiffness, often in one knee, weeks to months after a tick bite.
• Hypermobility and connective tissue disorders.
• Medicines: some aromatase inhibitors used for breast cancer commonly cause joint stiffness.

Stiffness all over the body

Widespread stiffness can come from polymyalgia rheumatica, fibromyalgia, hypothyroidism, viral illnesses, statin side effects or Parkinson's disease. See stiffness all over.

How doctors find the cause

A doctor will ask which joints are stiff, how long morning stiffness lasts, about swelling, injuries, family history, skin, eye and bowel symptoms, and examine the joints for swelling, warmth and range of motion. Tests may include:

• blood tests: ESR and CRP (inflammation), rheumatoid factor and anti-CCP antibodies, uric acid, thyroid function, ANA
• X-rays: show joint space narrowing and bone changes in osteoarthritis, and erosions in advanced inflammatory arthritis
• ultrasound or MRI: detect early inflammation
• joint fluid test: a needle sample checks for infection or crystals

Treatment and relief for joint stiffness

Keep moving

Regular activity is the most effective treatment for most stiff joints. Aim for gentle range-of-motion exercises daily and about 150 minutes a week of low-impact activity such as walking, cycling, swimming or water aerobics. Strengthening the muscles around a joint reduces strain on it.

Heat and cold

• Warmth (a warm shower, bath or heat pack for 15 to 20 minutes) loosens stiff joints in the morning.
• Cold packs help with swelling and flares.

Medicines

• NSAIDs such as ibuprofen or naproxen, or topical NSAID gels for knees and hands, following the label dose. Avoid oral NSAIDs if you have stomach, kidney or heart problems without medical advice.
• Acetaminophen (paracetamol) has a modest effect.
• Disease-modifying drugs (such as methotrexate) and biologics for rheumatoid and psoriatic arthritis, prescribed by a rheumatologist.
• Steroid injections for a single inflamed joint or frozen shoulder.

Other measures

• Weight loss: each pound lost removes about 4 pounds of load from the knees during walking.
• Physical and occupational therapy: exercise plans, splints and joint protection techniques.
• Supportive footwear and walking aids if needed.
• Joint replacement for severe osteoarthritis of the hip or knee that limits daily life.

Frequently asked questions

What causes stiff joints in the morning?

Short morning stiffness under 30 minutes is common with osteoarthritis and aging. Stiffness lasting longer than 30 to 60 minutes, with swollen or warm joints, suggests inflammatory arthritis such as rheumatoid or psoriatic arthritis, or polymyalgia rheumatica in people over 50, and needs medical assessment.

How do I relieve joint stiffness?

Move the joint gently and regularly, use warmth in the morning, stay active with low-impact exercise, and strengthen surrounding muscles. Over-the-counter anti-inflammatory gels or tablets can help when suitable. Persistent or swollen stiff joints need a doctor's assessment.

Is joint stiffness a sign of arthritis?

Often, yes. Osteoarthritis and inflammatory arthritis both cause stiffness. But stiffness can also come from injury, inactivity, frozen shoulder, hypothyroidism, viral illness or some medicines. The duration of morning stiffness and the presence of swelling help tell the causes apart.

Why are all my joints stiff and achy?

Widespread joint stiffness can come from a viral infection, rheumatoid arthritis, polymyalgia rheumatica, hypothyroidism, fibromyalgia, or medicines such as aromatase inhibitors. If it lasts more than a few weeks or comes with swelling, fever or weight loss, see a doctor.

Can dehydration cause stiff joints?

There is no good evidence that mild dehydration causes joint stiffness. Staying active, maintaining a healthy weight and treating any underlying arthritis are much more important for joint health than fluid intake.