Shoulder destruction in rheumatoid arthritis Classification and prognostic signs in 83 patients followed 5–23 years

Abstract

We studied the natural course and the possibility of making prognoses about shoulder joint destructions in 83 patients with rheumatoid arthritis (RA) (166 shoulder joints). For this purpose, we used radiographic patterns and 2 indices (upward migration and medial displacement). The patterns of joint destruction were classified into 5 groups: 1) non-progressive type (n 74) with normal radiographs, only osteopenia or small erosions even after 15-20 years of RA; 2) erosive type (n 22) showing marginal erosions but no collapse; 3) collapse type (n 34) showing subchondral cysts, followed by collapse; 4) arthrosis-like type (n 12) showing arthrotic features; 5) mutilating type (n 14) showing mutilating bone destructions. From the radiographic findings and the 2 indices determined at 5-10 years, we could predict the prognosis of shoulder joint destruction after 15-20 years of RA. Our findings may be of value for selecting treatment, including surgery, for the rheumatoid shoulder.

Rheumatoid shoulder: Does minimally invasive therapy make sense?

“…[17] in einer Verlaufsbeobachtung erarbeitet. Die Autoren beschrieben unter Berücksichtigung und Vermessung der Verlagerung des Humeruskopfmittelpunkts nach medial und kranial 5 radiologische Formen [17,32]: F den so genannten "nichtprogressiven Typ" mit nur geringen entzündlichen Veränderungen, F die erosive Verlaufsform mit Usuren und Zysten ohne Verlust der Humeruskopfkontur, F den "Kollapstyp" mit rasch progredienten Humeruskopfzysten und Zusammenbruch des Humeruskopfs F eine "arthroseähnliche" Verlaufsform und F eine "mutilierende" osteolytische Verlaufsform.…”

Huge tumor-like subacromial bursitis associated with rheumatoid arthritis

“…There is no soft tissue swelling. The glenohumeral joint has been destroyed by RA showing joint-space narrowing, subchondral sclerosis, and osteophyte formation (arthrosis-like destruction reported by Hirooka et al9 )…”

Arthroscopic rotator cuff debridement in patients with rheumatoid arthritis

“…9,12,20 Radiographic changes may also be present, including osteopenia, proximal humeral subluxation, and glenohumeral and acromioclavicular erosions. 17,21,30,39 Although repair of the rotator cuff may be desirable, individual patient factors such as functional demands 16,38 and overall poor health status, along with the known risks associated with rheumatoid disease such as increased risk of infection 13,14 and associated systemic comorbidities, may discourage more complex reparative interventions. 35 Less complex procedures, such as debridement for rotator cuff tears, have been investigated, 26,31,32,39 but the success of rotator cuff debridement in patients with RA is not known.…”