The shoulder is commonly affected in RA, with 65% to 90% of RA patients reporting symptoms (mostly pain) affecting the shoulder. When RA affects the shoulder, it can make a range of common tasks and movements difficult or impossible, leading to pain and discomfort, as well as significant disability.1
As is true with RA and joints throughout the body, the sooner diagnosis is made and treatment initiated, the greater the likelihood that joint damage can be minimized or prevented. The availability of disease-modifying anti-rheumatic drugs (DMARDs) and newer biologics that are effective at slowing or preventing structural damage to the joints means that the shoulder and other joints can often be preserved and function maintained.1
How does RA affect the shoulder?
Pain and inflammation affecting the shoulder and resulting in a limitation of movement tends to occur only in the later stages of the disease. Inflammation and swelling of the shoulder may be difficult to detect because of the location of the joint. For instance, swelling is rarely detected by physical examination. Pain may occur during the night. Impairment of function typically results from a combination of factors, including pain, loss of muscular strength, and decreased range of motion due to swelling and joint deterioration. Co-occurring rotator cuff tears, commonly found in older patients, may lead to further impairment of shoulder function.1
How is RA-related shoulder involvement treated?
Treatment of RA symptoms affecting the shoulder depends on the severity of symptoms and the nature and extent of damage, as well as the patient’s goals and needs. Options include drug and non-drug treatments, and surgery.1,2
Drug treatments. The initial approach to treatment should involve medications to control inflammation and pain (including analgesics [NSAIDs], disease-modifying anti-rheumatic drugs [DMARDs], and glucocorticoid injection).1
Injection of glucocorticoids directly into the shoulder joint may be useful in controlling acute inflammation.1
Non-drug management approaches. Rest and/or restricted activity and application of heat or cold (for 20 to 30 minutes, two or three times per day) may be used to provide relief of acute pain in the shoulder.2
Physical therapy and other forms of rehabilitation (eg. massage) may be useful in maintaining and improving range of motion and strength.2
Additionally, use of dietary supplements, including glucosamine and chondroitin sulfate, may provide pain relief. However, solid scientific evidence of the benefit of such substances is currently lacking.2
Surgery. If joint symptoms do not respond to medication or other management approaches and there is progressive loss of function in the shoulder, surgical interventions may be used. The goal of shoulder surgery is to improve or restore joint function and to provide pain relief.
Arthroscopic surgery to remove damaged tissue from the joint is most effective if done early in the course of RA before damage is severe. This type of surgery may provide significant relief of shoulder pain, with effects lasting for an average of 6 years.1
Shoulder replacement surgery is considered when there is significant loss of joint space (visible on x-ray). Other factors that may influence the decision to have shoulder replacement surgery include level of pain, loss of function, rotator cuff injury, and patient preference. Replacement surgery is typically effective at providing long-term relief of pain.1