Shouldering the Complexities of Rheumatoid ArthritisShoulder arthritis is usually caused by osteoarthritis (OA). OA can happen after an injury or a fracture, or from the changes of aging. With OA, there is a gradual wearing away of the joint. Rheumatoid arthritis (RA) is different. RA is the most common form of inflammatory arthritis. It can affect many parts of the body, including the joints. Patients with RA of the shoulder may need very complex medical care.
This article gives an overview of the treatment of shoulder RA. The goal in treating RA of the shoulder is to stop pain, improve motion, and increase function. Getting there may take a series of steps, from drugs to physical therapy to surgery. Patients may need several kinds of doctors and therapists. Besides the regular (primary care) doctor, the patient may need to see an orthopedic surgeon, a rheumatologist, and physical and occupational therapists.
RA of the shoulder often comes on slowly and gets worse over time. Pain, swelling, and loss of motion occur as the joint and nearby soft tissues are affected. Pain may be mild at first with only small losses of motion. As the symptoms get worse, the patient loses function. It becomes hard to reach items on high shelves or a wallet in the back pocket. Over time, severe pain keeps patients from carrying out many daily tasks.
Doctors use X-rays, MRIs, and CT scans to see the amount and type of RA damage in the shoulder. Doctors base their treatment decisions on this information and the results of their exam. The first treatment steps are anti-inflammatory drugs and physical therapy. Surgery may be needed if drugs and physical therapy no longer control the pain. Loss of motion and function may also point to the need for surgery.
This author notes that many factors should be considered before doing shoulder surgery for RA. For example, the timing of the operation and the type of surgery depend on how much bone has been lost. If the shoulder joint is being replaced, the bone has to be strong enough to hold the artificial joint. Some joint implants can't be used in younger, more active patients.
Doctors agree that the most disabling problem should be taken care of first. Giving the patient as much function as possible is the goal. However, some doctors say that problems in the hand or wrist are more important than problems in the elbow or shoulder. Other doctors suggest that elbow motion is the key for patients to use both the hand and the shoulder. Sometimes, more than one operation is needed.
Clearly, treatment of RA of the shoulder is no simple task. Most patients, however, can find relief with some combination of conservative treatments, physical therapy, and surgery. The author encourages a team approach to tackle the problem.
Andrew L. Chen, MD, MS, et al. Rheumatoid Arthritis of the Shoulder. In Journal of the American Academy of Orthopaedic Surgeons. January/February 2003. Vol. 11. No. 1. Pp. 12-24.
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