Table 2. Themes and Illustrative Extracts.

Themes	Illustrative Extracts
Theme 1: Stiffness Relationship to Other Symptoms
Comparison with pain	The stiffness, I mean it's constant, all day long from the time you get up until you go to sleep. Your fingers, it just feels like they're constantly swollen, you go to bend them, you can feel the pressure in your hands, in your fingers, your ankles, your shoulders. You feel it. The pain's worse than the stiffness. Ten times worse than the stiffness. (Male, FG1) So I don't really remember life prior to, without having RA, and I will tell you my stiffness is more debilitating for me as compared to pain. (Female, FG1) And as painful as it is you still have to push through the pain or stiffness or whatever you want to call it and I think that we both pretty much identified that it's more pain than stiffness that drives us. (Female, FG4)
Distinguishing among multiple symptoms	It's not literally well you're just stiff and you're not in pain. They all, they come hand in hand. (Male, FG1) I have a problem with fatigue and I have to battle that to get to the stiffness. (Male, FG1) It's very hard to describe because when I have trouble in the joints, it's more just pain. I mean you could call it stiff but the fact is that it's just hard to move because it hurts. (Female, FG4) It's not stiffness, it's actually how much swelling or how much pain do I experience. And I'm translating that into that means I'm not very flexible there. (Female, FG4)
Differentiating RA from non-RA stiffness	There is a different type of stiffness that you have from just doing a big race. And your muscles are tired and achy. There's a difference from RA stiffness and feelings. (Female, FG1) What's in my neck is you know, osteo, the doctor well, he told me. (Female, FG1)
Others' understanding of symptoms	F2: Pain, I think people have an understanding, where but with stiffness, I don't think they do. They don't' understand when I take forever to get out of the chair or I sometimes have to roll out of the chair. F3: Right. M3: And roll out of bed. F2: I know people, like my husband for example, just looks at me. And I tell people, just leave me alone. Just let me just do what I have to do but, like to roll, like that's just that and that's pure stiffness. (FG1) I know when that flare is coming, if I've been stiff I'll say you know, I'm a little stiff and […] my husband's always oh shake it off, get up, stretch, come on, pull, let's go and I'm like, don't pull that joint, don't pull on me like that. (Female, FG1) I was parking close and people would just kind of look at me like why do you have a handicap sticker? Or I would go to the mall, and I would feel bad parking there because on the outside it really doesn't look like there is anything wrong with [me] and [they] don't really realize that every step that [I] take is hurting. (Female, FG2)
Theme 2: Exacerbating or Alleviating Factors and Self-Management
Exacerbating Factors
Weather and changing Seasons	F2: And I find that the weather though, like when it's a cold and drizzly day, I'm more stiff, not that I'm going to be […] F3: When it's damp, right. F2: That makes me more stiff, and where I just know it's going to be a horrible, like everything, just the fatigue, but it's the stiffness during those days, which I hate. So it's the weather for that, I know that's just a bad thing. […] M3: I know it's going to rain that next day, just that, at that night, I'll feel it, I really believe F2: Yeah, and I know when it's going to be a bad day. F3: My body will forecast it. F1: Yeah.”(FG1) The changes in the season so going from winter to spring, usually you get kind of more swelling and like achy but then you get settled into the season and it kind of goes away and then when you go summer to winter, you get achy again. (Female, FG2) You know, people have asked me if the weather affects it. It doesn't affect mine. (Female, FG2)
Immobility	If I have to take a drive anywhere over 45 minutes, it takes me forever to get out of the vehicle. (Male, FG1)
Physical activity	I always think when I'm having the stiffness I just need to get the blood flowing and then I can even run, and then I always get stiffness right after I run. (Female, FG1) I was very active with my children and the last time I went horseback riding I went into total lock up. I couldn't even get off of the horse. (Female, FG4)
Other exacerbating factors	I was really stressed out from some family things and it immediately made me flare up. […] And I think the stiffness is for me, is what makes me, that and the fatigue is what's so much more debilitating. (Female, FG1) Moderator: Do you find that stress can make it worse? Your stiffness? Participant: I never connected the two and that's one of the things I experience is that there wasn't really a rhyme or reason. It just happens.” (Female, FG2)
Alleviating Factors
Warmth	I would go in the shower right before going to school […] my parents would yell at me because I would be there for so long. […] I think that it was that warm feeling […] I have no stiffness then. But I needed that shower really bad. […] I have the temperature raised up really high in my house. (Female, FG1) I love going into the sauna […] and I do my stretching exercises in the sauna when I'm all nice and warm. (Female, FG4)
Physical activity	In the morning time or when I have some stiffness in the evening time or even actually at work, I'll close the door and I'll just do a backbend. (Female, FG1) I try and go swimming three times a week and I think it really, really does help. (Female, FG4) I just make myself do something, physically [fast walking], every single day because if your blood is moving, you're going to move and I always feel better. I really do. (Female, FG4)
Moving, adjusting position and getting comfortable	[car trips] prop a little rolled pillow behind my head, put the seat as far back as I can, and sometimes I'll put my feet on the dash […] I have to constantly be adjusting so that I don't get stiff. (Female, FG1) I would get out of bed and I would just slowly move my hands to get the stiffness out of them because they would be stiff and my feet, I would just sit on the side of the bed and move my feet around before I got out of bed. (Female, FG2)
Other alleviation strategies	When I was in my flare-up part of it last week, I made sure I was really strict on my diet, and even now maintaining a raw diet of eating all fresh vegetables […] I do find that for me that really does make a difference. (Female, FG1)
Self-Management and adaptation
	And then I start hurting like crazy, that's why I don't drive. If I drive from here to the ocean, I can't pick my arms up. (Male, FG1) It's difficult for me to kneel sometimes it's painful and it's a catch 22 to do exercise 'cause I know you should do exercise but then you get reminded how much of a cripple you can be so it, that to me is the psychology behind it, that I'm not, it reminds me when I do physical that I can't do as much as I used to. I've got an ego and don't want to be ill so that's been the hardest part of it. (Female, FG4)
Theme 3: Stiffness Timing and Location
Timing
Upon awakening	The stiffness with me, I would feel it first thing in the morning when I get out of bed. I would feel it in my feet but once I walked around, by the time I got ready to leave, it would be gone. (Female, FG1) I would have it in my hands only in the morning but I would move around and it would get better but then after I got into a nice warm shower by the time I got out of the shower, it was gone. (Female, FG2) It's funny when it was in my feet, I had stiffness, it would be about five minutes in the morning. I would wake up and you know walk around or as I was getting dressed. Then they just kind of naturally loosen up and they get tired by the end of the day. (Female, FG2) Well you know that initial stiffness where it takes a while to start moving around might only last five minutes. (Female, FG4)
All day	The stiffness, I mean it's constant, all day long from the time you get up until you go to sleep. (Male, FG1)
Unpredictable	Usually I'll get up and I'm okay in the morning, it just depends on if you get a flare or, you know, the fatigue. It kills me. (Female, FG1). In the mornings, the only thing I felt was my feet, the stiffness in my feet but when I would get the stiffness in my hands, it would just come at any time and I just couldn't use them. (Female, FG2)
End of day	Stiffness is something that would loosen, become un-stiff or maybe go away. When it was in my feet, which was like just on the balls of my feet or those joints, it would loosen up and go away as I walked around during the day and then you would get more tired at the end of the day and they would be like achy from overuse. (Female, FG2)
Location
Many joints affected	M1: RA don't pick one joint. F2: Yeah. M1: It's in your jaws, it don't matter, your back. F1: No it's not all my joints. It truly isn't. Basically, this hand more than this, but this one's been getting into it more, and my ankles and my shoulder. Because what's in my neck is you know, osteo, the doctor well, he told me. (FG1)
Different joint symptom combinations	My knuckles are swollen right now and not stiff. My wrist is stiff but my knuckles aren't, my fingers aren't. (Male, FG1) It depends on where the pain is. If it's on the bottom of the feet, it can be a pain but it can be stiffness. (Female, FG2) The swelling would be there regardless of whether the stiffness was there or not. I couldn't wear my rings […] but my stiffness in my hands, I think that was the worst stiffness that I experienced. (Female FG2)
Theme 4: Individual Context and Meaning
Descriptors and explanations for stiffness	I feel like the Tin Man, you know, get me a bit of oil or something. (Female, FG1) I mean, the stiffness come from the pain in the joints because you're not going to move when you have the pain […] So then, since you don't move the joint, when you do move it, it's going to be a little stiff. You're going to have a little of that Tin Man in you from the Wizard of Oz. (Male, FG2)
Normal/constant part of RA	I recognize though I have RA normal. So my RA normal is always going to have some pain. I tell that all the time to my family. Every day I have pain. It's never going to go away. Stiffness every day I'll have that. Fatigue though, I don't, that's different, fatigue I don't have every day. But stiffness and pain I do, and that's just part of RA. (Female, FG1) If you've had it a long time you just get used to things, you don't realize what's going on. You're just used to it. (Male, FG1)
Connected with RA flare	If it is only in the morning and just a short time [it's] more under control. But if you're getting it throughout the day […] that's where I know for me […] this is getting to be a flare-up. (Female, FG1) Mine is in the morning, I have some stiff, I know I'm always going to have some stiffness but it's nowhere near as when I'm in a flare-up. (Female, FG1) If I get a flare I know it's coming because it'll start real small, like it's going to be this wrist. The stiffness will start and then the pain will start, and then it'll just grow and grow into the big hairy monster it turns out to be. (Male, FG1) That's the only time I have stiffness in my hands, when I'm in a flare. (Female, FG2)
Theme 5: Impact on Daily Life
Perseverance	I always get stiffness right after I run […] every time I'm running I'm always thinking, I'm always saying to myself, you have RA and you're running, you're doing so good (Female FG1) If you stop moving you lose it. And so I have just forced myself. There are days I trudge down to my treadmill and the last think I want to do is that treadmill (Female FG4)
Mobility and adaptation	It always takes you longer. There are no shortcuts with RA. (Male, FG1) M2: Like a shirt like he's got on with the buttons, it would take me ten minutes to get that shirt buttoned up. M1: I haven't worn a shirt like that in years. F2: Yeah, and consciously about the medications that I got, like in terms of getting the arthritis caps or just even with a prescription M1: I keep a barstool in the kitchen so I can cook. […] Because of my stiffness. F3: Yeah, to sit down. M1: Oh yeah. I'll drag the barstool over and do dishes. F2: Shopping, grocery shopping. I always have to use a cart. M1: Yeah, to hold on. F2: I purposely just buy really fat pens. M1: I have ice cream scoops that have a real fat handle. (FG1)
Dependence on others	I could, I can deal with the stiffness. I mean it does hinder me, I feel like a burden around home, got to get people to open jars for you, you know, carry things for you.(Male, FG1) I had the help of my husband of course, because I went through a time when I couldn't dress myself, couldn't open jars (Female, FG2)
Vulnerability, fear, isolation	You can't get up off a chair, and forget it, if I sat on the ground, I would need help […] If this place caught on fire and I was on that ground, I'm dead, because I am not getting up. (Male, FG1) I think the stiffness is what makes you insecure. […] it makes me self-conscious and insecure about that you're more likely to fall, that you kind of just, you feel unsteady. (Female, FG1) You know that any minute you might not hit the step just right or you know you might not lift your foot up exactly right so you'll go off the front of the edge of the step or something. (Female, FG1) When you do get in those flare-up times and those really, really stiff times, like when it's like cold, and damp and God forbid that it snows you know, and I dread going outside and perhaps falling. (Female, FG1) It's that fear of falling or when you said like someone bangs into you, like sometimes my dog bangs into me and it is excruciating. (Female, FG1) I can't go to a football game, I can't go to a concert […] I don't feel secure going up them 20 steps to get in that seat and then sliding by people also scares the heck out of me. (Male, FG1)