The Shoulder

Reumatoid-type Arthritis

Rheumatoid arthritis (RA) is an autoimmune disorder of unknown etiology characterized by symmetric, erosive synovitis and sometimes multisystem involvement. Any joint can be involved, but the proximal interphalangeal and metacarpophalangeal joints of the hand and the wrist are preferential sites, as well as the metatarsophalangeal joint of the foot, the knee and the joints of the shoulder, the ankle and the hip.

Symmetry is the hallmark of joint involvement. The synovium of bursae and tendon sheaths can also be affected. It gives rise to pain and stiffness, usually greatest in the morning. There is a marked capsular pattern with a spastic end feel. Warmth and tenderness can be palpated over the joint.

Conventional radiography remains the standard imaging technique for joint studies in the patients with suspected RA.

The first radiological signs are osteoporosis and joint space narrowing.
Later chondral erosions and small bone erosions at the joint margin are seen.
Marginal and central erosions follow in advanced stages and finally fibrous ankylosis, joint deformities (subluxations and dislocations), fractures and fragmentations are typical findings of more advanced RA.

RA is best treated systemically; local intra-articular injections are only used as a secondary aid.

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