The rheumatoid shoulder: current consensus on diagnosis and treatment - 01/01/05

Doi : 10.1016/j.jbspin.2005.03.013

Thierry Thomas ^a,⁎ , Eric Noël ^b, Philippe Goupille ^c, Bernard Duquesnoy ^d, Bernard Combe e
for the GREP^f
^a Rheumatology Department, St-Etienne University Hospital, Boulevard Pasteur, 42055 Saint-Etienne cedex 02, France
^b Saint-Anne Lumière Hospital, Lyon, France
^c Rheumatology Department, Tours University Hospital, Tours, France
^d Rheumatology Department, Lille University Hospital, Lille, France
^e Rheumatology Department, Montpellier University Hospital, Montpellier, France
^f GREP: French Shoulder Rheumatic Diseases Group, a section of the French Society for Rheumatology

^*Corresponding author. Tel.: +33 4 77 12 76 49; fax: +33 4 77 12 75 77.

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Abstract

Shoulder involvement is usually inconspicuous in patients with rheumatoid arthritis, and the clinical manifestations are nonspecific. Nevertheless, shoulder involvement should be sought routinely and detected early. Range of motion at the shoulder should be evaluated. Although normal radiographic findings do not rule out shoulder involvement, radiographs are crucial for detecting micro- and macro-geodes during follow-up. The development of glenohumeral joint space narrowing is a turning point that indicates a risk of rapid joint destruction. Magnetic resonance imaging is useful for assessing the lesions and guiding the treatment strategy. Stepwise use of local interventions as indicated by imaging findings is recommended. Joint replacement should not be left too late, and surgical procedures on the shoulder should be built into the overall treatment plan.

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Keywords : Arthroplasty, Rheumatoid arthritis, Shoulder