Rheumatoid Arthritis Onset from Shoulder Monoarthritis

Abstract

Purpose

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

Ethics Approval and Informed Consent

The protocol of this study was approved by the institutional review board of Tottori University Faculty of Medicine (Reference number 19A089). This study has been conducted in accordance with the Declaration of Helsinki. Informed consent was obtained from Patient 1 and Patient 2 for publication of all data including images. Informed consent was obtained from all individual participants included in the study.

Disclosure

Professor Hideki Nagashima reports grants from Shimizu Hospital, Motomachi Hospital, Misasa Onsen Hospital, Tsuyama Daiichi Hospital, Yowakai, Kaken Pharmaceutical Co., Ltd, Pfizer Japan Inc., MSD, K. K., Shionogi & Co., Ltd., Nippon Zoki Pharmaceutical Co., Ltd., Kawashima Corporation, AbbVie GK, Grants-in-Aid for Scientific Research, personal fees for speaker honorarium from Chugai Pharmaceutical Co., Ltd, Asahi Kasei Pharma Co., Taisho Toyama Pharmaceutical Co. Ltd., Eisai Co., Ltd., Astellas Pharma Inc., Teijin Pharma Ltd., Takeda Pharmaceutical Co., Ltd., Daiichi Sankyo Co., Ltd., Stryker Japan KK, AOSpine, Eli Lilly Japan K. K., Hisamitsu Pharmaceutical Co., Inc., Nippon Sigmax Co. Ltd., Globus Medical Japan, Inc, Becton, Dickinson and Company, NuVasive, Inc., Kyocera Co., and Johnson & Johnson K.K., outside the submitted work. Professor Hiroshi Hagino has received lecture fees or grants outside the submitted work from Amgen Inc., Asahi Kasei Pharma Corp., Astellas Pharma Inc., Chugai Pharmaceutical Co., Ltd., Daiichi Sankyo Co., Ltd., Eisai Co., Ltd., Eli Lilly Japan Co., Ltd., Pfizer Japan Inc., Mitsubishi Tanabe Pharma Corp., Mochida Pharma Co., Ltd, Ono Pharmaceutical Co., Ltd., Pfizer Japan Inc., Taisho Pharmaceutical Co., Ltd., Teijin Pharma Ltd., and UCB Japan Co., Ltd. The authors report no other conflicts of interest in this work.