I have figured out how to reduce the morning stiffness and pain of my RA. I do two things.
- First, I take pain medication. I wake up in the early morning to use the restroom. At that time, I take a dose of my pain medication. Before I go to bed, I put a dose in a little bowl on my night table. It is easy to access and I will know whether or not I had taken it. Then I go back to sleep for about an hour or so. It relieves me of the pain that saturates my body in the morning. I no longer feel discouraged. I am ready for my day.
- The second thing I do is read the paper while I have my freshly brewed Starbucks French Roast. I have time to center myself as I work out the nighttime kinks. I read the New York Times on my Kindle. I have a cover for my Kindle that also acts a stand for it (something like a picture frame easel). This sits nicely on the arm of my bedroom sofa. All I need to do is turn the digital page with my finger as I drink my coffee. My stiffness falls away and I am ready for my day..
I know much of the literature reads like the only time a person suffers from RA is in the morning. Mine is more generous, I simmer all day and then sometimes I get hit hard in the evening also. About eight or nine maybe. All my affected joints ache. It is wearing. The pain medicine does not seem to help in the same way it does in the morning. This is persistent pain that also requires distraction. I rub diclofenac(Voltaren) gel into all the painful joints. It takes up to ten minutes to absorb. Keeps me occupied. It does help and it helps with the swelling. I also distract myself with a favorite television program or a good book. Those of us with RA are a creative bunch.
There is an increasing body of research on rheumatoid arthritis pain and on the inflammation of RA during the night. Nocturnal pain is more characteristic of those who have RA and less so for those with other inflammatory joint disorders. Nighttime pain is associated with more joint tenderness, more swollen joints, and elevated inflammatory markers. Simply said those with nocturnal pain have more active disease(a remark by Dr. Bernadette Rojkovich, rheumatologist, Budapest).
In healthy people the endocrine system produces a supply of cortisol in the middle of the night because in healthy people their inflammatory systems are most active at night. This enables the healthy body to rid itself of pathogens trying to get a foothold in the body. Nighttime is a good time for this as there is more energy available with muscle and digestion activity being less active.
Those with RA do not have an endocrine system that is working properly. It fails to make the normal production of cortisol and so it also fails to make the cortisol needed for the additional nighttime inflammation.
Many are now recommending that prednisone be taken at nighttime instead of in the morning. There is also a delayed release form of prednisone to target what would be the normal release of cortisol in the night. It costs more but it provides a targeted approach.
I take 4mg Medrol in the morning and 4mg Medrol in the evening. It is the low dose that I see providing me with the necessary glucocorticoids my own adrenals fail to produce.