Shoulder Pain, Swelling, and Inflammation

In most cases, shoulder pain and inflammation tend to happen in the later stages of rheumatoid arthritis (RA) and in people who are older when they develop RA. It usually causes a reduced range of motion and decreased muscle strength in the shoulder. This can make it hard to do everyday tasks like reaching up to a shelf or lifting your arms to wash your hair.1,2

One study found that RA decreases shoulder muscle strength even in people who are not experiencing other symptoms. The findings highlight the importance of doctors testing for shoulder function at the time of RA diagnosis instead of only when symptoms affect the shoulder. The sooner treatment is started, the greater chances that joint damage can be reduced or prevented.2

How does RA affect the shoulder?

RA is common in the 2 joints of the shoulder, though it tends to affect them mainly in the later stages of the disease. The joints include:3

  • Acromioclavicular (AC) joint– This is located where the collarbone (clavicle) meets the tip of the shoulder blade (scapula)
  • Glenohumeral joint – This is located where the head of the upper arm bone (humerus) fits into the scapula

In people with RA, the body’s immune system attacks the healthy tissues inside the joints. This causes an inflammatory response that results in swelling and pain, especially when the joint is used. Common symptoms of RA in the shoulder joints include:3-5

  • Redness or warmth in or around the shoulder
  • Tenderness
  • Pain at night
  • Limited range of motion
  • Pain focused on the top of the shoulder that may radiate to the side of the neck if the AC joint is affected
  • Pain centered in the back of the shoulder if the glenohumeral joint is affected

Swelling is also common, though it is often hard to detect during a physical exam. As the condition progresses, it may also cause a grinding, clicking, or snapping sound when you move your shoulder.3

RA sometimes symmetrical, which means it usually affects the same joints on both sides of the body. As the condition gets worse, ligaments, joints, and cartilage become more damaged. Glenohumeral joint damage often leads to severely limited movement that is sometimes called “frozen shoulder syndrome.”3-5

There are periods of time when RA symptoms become worse, known as flare-ups or flares. These flares are then followed by periods when symptoms decrease.

The exact cause of RA is not known. Researchers believe that some people have genes that make them more likely to develop RA. However, this does not mean that people with these genes automatically develop RA. There is usually something that triggers the condition, like an infection. This causes the immune system to start attacking the joints.4,5

How is RA shoulder pain treated?

There is no cure for RA, so treatment focuses on ways to manage the inflammation, pain, and stiffness that affect the shoulders. Treatment methods depend on your symptoms and how severe they are. The goals of RA treatments include:1,6

  • Stop or reduce inflammation
  • Relieve symptoms
  • Prevent joint and organ damage
  • Improve function and well-being
  • Reduce long-term complications

Options include both nonsurgical and surgical treatments.

Nonsurgical treatments for RA shoulder pain

In most cases, treatment begins with nonsurgical options. They can help reduce your symptoms and help them from getting worse. The options may include:3

  • Limiting or stopping activities that make your shoulder pain worse. You might need to change the way you move your arm to do things.
  • Applying ice to your shoulders for 20 minutes, 2 to 3 times per day, to reduce pain and inflammation. Do not apply ice directly to your skin.
  • Taking nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen to help reduce pain and inflammation
  • Applying moist heat to your shoulders
  • Doing exercises that help improve the range of motion and function in your shoulder. Your doctor may have you work with a physical therapist to find exercises that work best for you.
  • Getting steroid injections into your shoulder joints can help reduce inflammation, though the improvement is usually temporary

If the above steps do not control your RA symptoms, your doctor may prescribe disease-modifying anti-rheumatic drugs (DMARDs). These are drugs that are designed to stop the immune system from attacking the joints. This slows or prevents joint deformity. There are both benefits and risks of DMARDs, so talk to your doctor about whether these drugs are right for you.7

Surgical treatments for RA shoulder pain

If your symptoms do not respond to nonsurgical options or medicines and your quality of life has been impacted by them, your doctor might recommend surgery. The goal of surgery is to improve or restore your shoulder function and provide pain relief. Surgery options include:3

  • Arthroscopy – During this procedure, the surgeon inserts a small camera (arthroscope) into your shoulder joint. The camera displays images on a screen, and the surgeon uses the images to guide small surgical instruments. The surgeon then cleans out the inside of the joint. While the procedure provides pain relief, it does not eliminate arthritis from the joint.
  • Shoulder joint replacement (arthroplasty) – During this procedure, the surgeon removes the damaged cartilage and bones in your shoulder. They will then place new metal or plastic joint surfaces to restore your joint function. There are different types of shoulder joint replacement surgeries, including:
    • Hemiarthroplasty – Just the head of the humerus bone is replaced
    • Total shoulder arthroplasty – Both the head of the humerus and the glenoid are replaced
    • Reverse total shoulder arthroplasty – A metal ball is fixed to the glenoid, and a plastic cup is fixed to the upper end of the humerus
    • Resection arthroplasty – A small amount of bone from the end of the collarbone is removed, leaving a space that eventually fills in with scar tissue

Learn more about shoulder surgery

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Written by: Jonathan Simmons & Heather Morse | Last reviewed: October 2020.