A stiff price to pay: does joint stiffness predict disability in an older population?

Objectives: To describe the prevalence of joint stiffness and associated comorbidities in community-living older adults and to determine whether joint stiffness, independent of pain, contributes to new and worsening disability.

Design: Population-based cohort.

Setting: Urban and suburban communities in the Boston, Massachusetts, area.

Participants: Adults aged 70 and older (N = 765) underwent a baseline home interview and clinic examination, 680 participants completed the 18-month follow-up.

Measurements: Morning joint stiffness on most days in the past month was assessed in the arms, back, hips, and knees. Mobility limitations were measured using self-reported difficulty and the Short Physical Performance Battery (SPPB). The home interview and clinic examination included extensive health measures.

Results: Four hundred one participants reported morning joint stiffness, half of these with one site of stiffness and the other half with multisite stiffness. Twenty percent of participants with multisite stiffness and 50% with single site stiffness did not have a major stiffness-associated condition. After adjustment for pain severity and other covariates, multisite stiffness was associated with a 64% greater risk of developing new or worsening mobility difficulty (relative risk = 1.64, 95% confidence interval = 1.05-2.79). Those with multisite stiffness had declined more quickly in physical performance over the 18-month follow up.

Conclusion: Older adults with multisite stiffness are more likely to be at risk of disability than those without joint stiffness after accounting for pain severity and the presence of stiffness-associated conditions. Better assessment, along with strategies to prevent and treat multisite joint stiffness is needed to prevent or slow the progression of disability in elderly adults.