Open Access Rheumatology: Research and Reviews (May 2021)

Rheumatoid Arthritis Onset from Shoulder Monoarthritis

  • Ishida K,
  • Nagira K,
  • Hagino H,
  • Enokida M,
  • Hayashi I,
  • Hayashibara M,
  • Takeda C,
  • Nagashima H

Journal volume & issue
Vol. Volume 13
pp. 103 – 109

Abstract

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Koji Ishida,1 Keita Nagira,1 Hiroshi Hagino,2 Makoto Enokida,1 Ikuta Hayashi,1 Masako Hayashibara,1 Chikako Takeda,1 Hideki Nagashima1 1Department of Orhopedic Surgery, Faculty of Medicine, Tottori University, Yonago, Tottori, Japan; 2School of Health Science, Faculty of Medicine, Tottori University, Yonago, Tottori, JapanCorrespondence: Keita NagiraDepartment of Orhopedic Surgery, Faculty of Medicine, Tottori University, 36-1 Nishi-cho, Yonago, Tottori, JapanTel +81-859-38-6587Fax +81-859-38-6589Email [email protected]: To investigate the incidence and clinical characteristics of rheumatoid arthritis (RA) presenting with shoulder monoarthritis.Patients and Methods: Our study included 113 patients (77 females; mean age, 63.0 ± 13.1 years) whom we newly diagnosed with RA in 2012– 2016. We investigated cases with onset from shoulder monoarthritis. Specifically, we examined physical findings, blood test results, radiographic findings, magnetic resonance imaging (MRI) findings, and duration from initial visit to diagnosis. RA was diagnosed based on the 2010 American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) classification criteria.Results: Overall, mean 2010 ACR/EULAR criteria score was 6.8 ± 1.8, and median duration to diagnosis was 3 days (interquartile range: 0– 14). Two patients (1.8%) were identified as having RA with onset from shoulder monoarthritis. Both were late middle-aged women with MRI findings of rotator cuff tear and remarkable synovial proliferation. However, neither patient fulfilled the 2010 ACR/EULAR criteria. It took 85 and 98 days to make a definitive diagnosis, respectively.Conclusion: Early diagnosis is difficult when RA synovitis develops from shoulder monoarthritis, especially, in elderly patients who have a rotator cuff tear. In addition to MRI, culture-based and pathological examinations may be helpful for early diagnosis of RA.Keywords: rheumatoid arthritis, monoarthritis, shoulder, rotator cuff tear

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