Rheumatoid arthritis hurts more at night or during the day?

Written by Liu Li Ning

Rheumatology

Updated on January 05, 2025

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The pain of rheumatoid arthritis is irregular. It can hurt at night or during the day, and it varies from person to person. The onset of rheumatoid arthritis is somewhat related to streptococcal infection. Clinically, it mainly presents as migratory swelling and pain in the large joints of the limbs, generally without leaving joint deformities. The onset of rheumatoid arthritis is related to streptococcal infection, so it requires treatment with penicillin antibiotics. During the acute phase, it is also recommended to use non-steroidal anti-inflammatory drugs to alleviate symptoms. Commonly used drugs include sustained-release capsules of diclofenac sodium, meloxicam, or etoricoxib.

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Difference between arthritis and rheumatoid arthritis

Arthritis is typically osteoarthritis, a chronic inflammation characterized primarily by degenerative changes in joint cartilage, followed by bone proliferation, making it a chronic disease. Early pathological changes include alterations in joint cartilage, such as subchondral bone extrusion, followed by changes in the muscles surrounding the periosteum and joint capsule. Early radiographic examinations can provide a definitive diagnosis. Its symptoms primarily manifest as pain. For rheumatoid arthritis, it generally presents as morning stiffness and joint swelling and pain more severe than in the surrounding area, which can essentially confirm a diagnosis. It usually affects large joints such as the knee, shoulder, or wrist joints, typically presenting as migratory pain. A definitive diagnosis can usually be made by testing for rheumatoid factor, with an anti-O level exceeding 500 units. Additionally, there may be a slight increase in white blood cells, accelerated erythrocyte sedimentation rate, and elevated C-reactive protein. Examination of the synovial fluid shows increased white blood cells and neutrophils. In such cases, using anti-rheumatic drugs might suffice, but it’s also crucial to ensure rest and local heat application. These two types of arthritis fundamentally differ.

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Rheumatoid arthritis massage techniques

For the acute phase of rheumatoid arthritis, which is when the joints are significantly swollen and painful, it is not advisable to perform any form of massage. Both massage and intense exercise could potentially worsen the joint swelling and pain. At this time, what is needed is strict bed rest. After the acute phase of the joints eases, then consider some methods of exercise. In managing the acute phase of rheumatoid arthritis, one can consider using some anti-inflammatory pain relievers. The most commonly used are non-steroidal pain relievers, such as diclofenac sodium, to control joint pain, rather than massaging the joints, as this could only make the condition worse. (Please follow medical advice regarding specific medications.)

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The difference between rheumatic arthritis and rheumatoid arthritis

Rheumatic arthritis is a reactive joint pain that occurs after a streptococcal infection. In addition to joint pain, common symptoms include mitral valve stenosis in some patients, skin erythema, and some patients may also exhibit symptoms such as chorea. Patients with rheumatoid arthritis often show symmetrical swelling and pain in the joints of both hands. Blood tests reveal significantly elevated levels of rheumatoid factor, anti-CCP antibodies, and AK antibodies. Inflammatory indicators such as erythrocyte sedimentation rate and C-reactive protein also tend to be significantly elevated. The main difference between rheumatic arthritis and rheumatoid arthritis is that rheumatic arthritis can involve cardiac and skin pathologies, while rheumatoid arthritis primarily manifests as joint-related pathologies.

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Treatment of Acute Flare-ups of Rheumatoid Arthritis

During the acute phase of rheumatoid arthritis, typical treatment includes absolute bed rest and avoiding intense physical activities, followed by a diet rich in fresh fruits and vegetables containing vitamins. Medication-wise, sodium diclofenac or meloxicam are used, which are non-steroidal drugs that relieve joint pain. If these drugs are not effective, steroids such as methylprednisolone are administered, initially at doses of 20 mg or 40 mg, until the pain eases, then gradually reducing the steroid dosage. During steroid treatment, it's also important to prevent side effects, namely, by supplementing with calcium and incorporating drugs that protect the stomach lining. (The above medications should be used under medical supervision.)

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Can rheumatoid arthritis be cured?

Rheumatoid arthritis is difficult to completely cure without medication, as it is a chronic inflammatory disease of the immune system that requires lifelong medication. The main treatment plans include the following three categories: The first category is anti-inflammatory and analgesic, which includes non-steroidal analgesics and low-dose corticosteroids. The second category, which is also the most important treatment, involves the use of immunosuppressants. Commonly used immunosuppressants include methotrexate and leflunomide. If the patient does not respond well to anti-inflammatory analgesics and immunosuppressants, treatment with biological agents may also be considered. (Medications should be used under the guidance of a doctor.)