"Stiffness has different meanings, I think, to everyone": examining stiffness from the perspective of people living with rheumatoid arthritis.

OBJECTIVE

Stiffness is a well-recognized symptom of rheumatoid arthritis (RA). It is frequently queried during clinic visits as an indicator of disease activity and was included in the 1961 and 1987 RA classification criteria. Little is known about how people with RA experience stiffness and its impact on their lives.

METHODS

We conducted 4 focus groups including 20 people with RA (4-6 participants per group) from 1 academic clinical practice and 1 private practice to generate accounts of stiffness experiences. Qualitative inductive thematic data analysis was conducted.

RESULTS

Five overarching themes were identified: relationship of stiffness with other symptoms, exacerbating or alleviating factors and self-management, stiffness timing and location, individual meanings of stiffness experiences, and impact of stiffness on daily life.

CONCLUSION

Focus group discussions revealed individual stiffness experiences as diverse and complex. Several stiffness features were endorsed by a majority of participants, but few, if any, were universally experienced; thus, the significance of stiffness as an expression of the disease varied widely. Discussions yielded descriptions of how individual limits imposed by RA in general and stiffness in particular may change over time and were intertwined with adaptations to preserve participation in valued life activities. These results concerning the diversity of the stiffness experience, consequential adaptations, and its impact suggest that a more individualized approach to stiffness measurement may be needed to improve stiffness assessments.