Rheumatoid Arthritis

Anatomy

The shoulder is a ball and socket joint in the upper extremity that is in part responsible for the positioning of the hand in space. It is made up of the gleno-humeral joint, the acromio-clavicular joint and sternoclavicular joint. These joints are lined with cartilage (gristle) for smooth movement. Surrounding the joint is a capsule which is lined with a thin layer called synovium.

Causes

Rheumatoid arthritis is an autoimmune synovial disease, meaning that the body’s own immune system attacks the cells lining the joint (synovium) leading to pain, swelling and loss of function.

Symptoms

Pain often occurs in both shoulders and the pain is worse first thing in the morning. There may also be involvement of several other joints e.g. elbow, wrist and hand joints. The individual also feels generally unwell and may exhibit flu like symptoms.

Treatment

An X-ray is taken to rule out any structural bone and joint changes, and blood tests done to confirm the diagnosis. Once it has been made, rheumatologists usually initiate the treatment. It normally takes the form of anti-inflammatory medication and disease modifying anti-rheumatic drugs (e.g. methotrexate, sulfasalazine etc.) If these control symptoms then no orthopaedic intervention is required but sometimes the disease process is so aggressive that it destroys the joint. This will be evident on an X-ray and in these cases a referral to an orthopaedic surgeon to discuss surgical options is warranted.

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