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Healing Choices for RA, Issue #022 --Are tendons involved in morning stiffness 7 tipsitis
April 01, 2017

Morning stiffness involves tendonitis: 7 tips for Relief

Two recent studies suggest that inflamed tendons are involved in morning stiffness of rheumatoid arthritis [1, 2]. More common names of inflamed tendons or tendonitis include tennis elbow and bursitis.

Morning stiffness is a key hallmark of rheumatoid arthritis, according to the 1987 classification criteria [3].

Morning stiffness affects daily life—both the ability to perform work and the tasks of daily living. And the joy of movement for patients! RA patients with morning stiffness have more difficulty playing with family and working a fulltime job.

Most RA symptoms and markers don't correlate with morning stiffness?

Standard markers of RA do NOT correlate with morning stiffness. For example, tender joint count, swollen joint count, C-reactive protein (CRP), erythrocyte sedimentation rate (SED rate) do not correlate with morning stiffness.

Complex scores of RA symptoms also do not correlate with morning stiffness. For example, the Disease activity score (DAS)-28, Simplified Disease Activity Index (SDAI), ACR Core set, and the 2011 definition of remission by American College of Rheumatology and the European Congress of Rheumatology, also do not independently affect morning stiffness.

Despite morning stiffness being common among RA patients and causing significant loss of work, the 2010 classification criteria did not include morning stiffness as a characteristic of RA.

Ultrasound reveals tendonitis correlates with morning stiffness

Clinicians measured the amount of inflammation in the joints and its tendons (tenosynovitis) with an ultrasound machine. Ultrasound machines are often used during pregnancy to view the developing fetus (unborn baby).

Inflammation of the lining of the joint only (synovitis) did NOT correlate with morning stiffness.

In contrast, patients with inflammation of both the tendons and joint lining (tenosynovitis) had significantly more morning stiffness than other RA patients.

My take: support the health of your tendons.

Tendons transfer the muscle’s pull to the bone. Tendons respond to exercise by becoming stronger. Conversely, immobilization can lead to loss of their strength (because it’s not needed).

Tendons can repair themselves after injury with sufficient nutrients. They are rich in calcium, phosphorous, sulfur, and trace minerals.[4]

Tendons are made of proteins including collagen, elastin, and proteoglycans which can resist compaction. Your body needs enough manganese, magnesium, zinc, vitamin B6, B12, and whole vitamin C complex to repair tendons and ligaments. A recent study suggests that RA patients can benefit from consuming more anti-oxidants, including those in pomegranates.

Enjoy these 7 Food groups and help repair the damage to tendons

!. All types of colorful vegetables , especially broccoli, kale, spinach, and winter squash.

2. Berries and Pineapple. Berries are delicious and contain the whole vitamin C complex which is essential for rebuilding collagen of the tendons. Besides berries, consider including bell peppers, kiwi fruit, and citrus fruits.

3. High quality meat or eggs from pasture-raised animals or wild caught fish from relatively pure waters are needed to provide sufficient amino acids to repair the damaged tendons.

4. High potassium foods including apricots, avocados, bananas, black-strap molasses, cantaloupe, cabbage, dates, figs, honeydew, kiwis, raisins, white beans, winter squash, and yams.

5. High magnesium foods including fish, dairy products, and meat, apples, apricots, avocados, bananas, black-strap molasses, brown rice, cantaloupe, dates, figs, greens, winter squash, and yams.

6. Bone Broth It’s very rich in nutrients needed for healthy joints. And it’s easy to make (cook the bones in a crockpot on high for 16 to 24 hrs, harvest, cool, and freeze or use). We use it to cook our brown rice, or quinoa, or to make a broth-based sauce rather than a cream sauce for meats.

7. Snack foods: Consider eating raw veggies with regular hummus or white bean hummus for a snack, ground flax seed (kept in freezer) on hummus or nut butter on rice cakes, a piece of fruit, carrot sticks, or kale chips, etc.

Two new web pages on role of infections

BTW, I’ve added 2 web pages: one on bacterial infections a second on viral infections. . Hope neither bacterial, viral or Mold infections are bothering you, but you may want to check them out.

Wishing you and your family a rapid healing journey,


Kathy Molnar-Kimber, Ph.D.

Private consultations are available.

Please note: the information on this website is a sharing of information and knowledge from the research and experience of Dr. Molnar-Kimber and her community. It is not intended to replace your one on one relationship with a qualified health care professional. It also is not intended to be medical advice. However, it is often observed that patients who take a major interest in their disease and learn as much as they can about their disease and potential treatments often improve faster than those who don’t. Dr. Molnar-Kimber encourages you to make your own health care decisions based upon your own research and discussions with your qualified health care professional.

Selected References

1. Kobayashi, Y., K. Ikeda, T. Nakamura, et al. Severity and Diurnal Improvement of Morning Stiffness Independently Associate with Tenosynovitis in Patients with Rheumatoid Arthritis. PLoS One, 2016. 11(11): e0166616.

2. Bellis, E., C.A. Scire, G. Carrara, et al. Ultrasound-detected tenosynovitis independently associates with patient-reported flare in patients with rheumatoid arthritis in clinical remission: results from the observational study STARTER of the Italian Society for Rheumatology. Rheumatology (Oxford). 2016. 55(10): 1826-36.

3. Arnett, F.C., S.M. Edworthy, D.A. Bloch, et al. The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum., 1988. 31(3): 315-24.

4. Kumai, T., G. Yamada, Y. Takakura, et al. Trace elements in human tendons and ligaments. Biol. Trace Elem. Res., 2006. 114(1-3): 151-61.

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