Analysis of Clinical Characteristics and Drug Treatment of Rheumatoid Arthritis Involving Shoulder Joints
10.11969/j.issn.1673-548X.2025.05.019
- VernacularTitle:类风湿关节炎累及肩关节的临床特征及药物治疗分析
- Author:
Fengyuan LI
1
;
Jianx-iong ZHENG
1
;
Rongjie ZHAI
1
Author Information
1. 730030 兰州大学第二医院
- Publication Type:Journal Article
- Keywords:
Rheumatoid arthritis;
Shoulder joint;
Musculoskeletal ultrasound;
Inflammation
- From:
Journal of Medical Research
2025;54(5):99-104,72
- CountryChina
- Language:Chinese
-
Abstract:
Objective The aim of this study was to analyze the clinical features,ultrasonographic manifestations,and medication characteristics of shoulder joint involvement in patients with rheumatoid arthritis during the course of the disease,and to explore the impact of shoulder joint involvement on the overall condition of RA,to further provide a basis for clinical diagnosis and treatment.Methods One hundred and forty RA patients who were hospitalized in our department between August 2023 and August 2024 were selected,and they were divided into the RA involving shoulder joint group and the non-involving group according to whether they were combined with shoulder pain or shoulder arthritis manifestations.The clinical data of the two groups were analyzed and compared,including disease activ-ity,imaging characteristics and treatment modalities.Results The RA-involved shoulder group was significantly higher than the non-involved group in pain visual analog scores,swelling,number of tender joints,28 arthropathic activity scores-erythrocyte sedimentation rate and C reactive protein scores,and the differences were statistically significant(P＜0.001).The two groups had significant differ-ences in blood tests,inflammation indexes,Rheumatoid factor and anti-CCP antibody and other laboratory tests were significantly differ-ent in the morning(P＞0.05),suggesting that shoulder joint involvement may not be readily recognized by routine laboratory tests.The ultrasonographic performance of RA involving the shoulder joint was classified into bilateral and unilateral lesions,in which the unilateral lesions were mostly acromioclavicular joint synovitis,and the bilateral lesions were predominantly humeral head bone erosions.Inflamma-tory changes of synovitis were predominantly in the acromioclavicular joint,while structural changes were focused on bone erosion of the humeral head.In patients with structural changes,the erythrocyte sedimentation rate and C-reactive protein level were higher than those of the group with inflammatory changes,and the difference was statistically significant(P＜0.05),while the difference between the rheu-matoid factor and the anti-CCP antibody was not statistically significant(P＞0.05).The proportion of patients with RA involving the shoulder joint using traditional synthetic antirheumatic drugs(csDMARDs)in combination with biologics(bDMARDs)or targeted syn-thetic antirheumatic drugs(tsDMARDs)was significantly higher,especially the proportion of csDMARDs in combination with bDMARDs was the most prominent.Conclusion Patients with RA who have shoulder involvement during the course of the disease usually present with worsening systemic symptoms,high disease activity,and ultrasonographic findings of synovitis and bone erosion in the shoulder joint.However,conventional laboratory tests and imaging methods lack specificity in the diagnosis of shoulder joint involvement,and therefore,clinical attention should be paid to shoulder joint involvement in RA to prevent disease progression from adversely affecting the overall prognosis.
