Rheumatoid arthritis (RA) is a long-term health condition that mainly affects your joints. It usually brings on pain and swelling in many joints at once, often in the hands, wrists, and knees.
It can also affect your shoulders, but that’s not likely to happen if your disease is mild, says Nilanjana Bose, MD, a rheumatologist with Lonestar Rheumatology in Houston, Texas. When the disease causes problems in your shoulder, that usually means it’s advanced, she says.
Even if you do get symptoms in your shoulders, your doctor has treatments that can help. Here’s what you need to know.
What Are the Symptoms of RA in the Shoulders?
You could have pain, swelling, and stiffness in any of the four shoulder joints:
- Where the bone in your upper arm (called the humerus) meets your shoulder socket
- Where your collarbone (clavicle) meets your shoulder blade (scapula)
RA can limit your shoulder’s range of motion. That’s how far you can move or stretch a body part.
You may also feel grinding or popping when you move your arm.
Is RA More Likely to Affect One Shoulder or Both?
The disease tends to bring on the same symptoms on both sides of the body, so it’s likely to affect both of your shoulders.
What Causes RA in the Shoulders?
That’s unclear. Experts aren’t sure why people get rheumatoid arthritis in general. They know it happens when something triggers your body’s immune system to go haywire and attack healthy tissues by mistake.
A protective lining called synovium covers your body’s joints. It lubricates and makes them easier to move. RA brings on inflammation in the synovium, which can cause cartilage to break down. Over time, that can lead to bone loss or “erosion.”
When that destructive process happens in a shoulder joint, you’ll want to get it diagnosed and treated as soon as possible. This will slow down destruction in the joint and keep your symptoms from getting worse.
How Do Doctors Diagnose Shoulder RA?
Your doctor may ask you about your symptoms and examine your shoulders. Even if you’ve already been diagnosed with rheumatoid arthritis, the doctor may want to do imaging tests – like X-rays or ultrasound – on your shoulders to look for signs of RA.
When RA affects the shoulders, it usually leads to more bone erosion and changes in the shoulder joint, Bose says. Symptoms of shoulder RA can also look like other conditions that bring on swelling and pain, like tendinitis and bursitis. When it’s hard to tell if it’s RA or something else, certain blood tests can look for markers of inflammation.
How Is RA in the Shoulders Treated?
Your doctor might be able to control the disease with medication. For instance, if you take disease-modifying antirheumatic drugs (DMARDs) and your RA becomes severe, the doctor may talk to you about ramping up to more powerful meds called biologics, Bose says. That depends on the person. A shoulder affected by RA might also benefit from:
- Shoulder replacement (if the disease is very aggressive and destructive)
Over-the-counter pain medications like acetaminophen or ibuprofen aren't recommended for RA because they do not change the course of the disease or stop joint damage. Ask your doctor which treatments are right for you.
Can Physical Therapy Help for Shoulder RA?
Yes. Bose says physical therapy can be a great part of your RA treatment plan, whether the disease affects your shoulders or other joints.
A physical therapist can teach you about exercises and devices that help you:
- Improve or maintain how well your shoulders work
- Manage shoulder pain
- Save energy
- Ease strain on your shoulder joints
- Do everyday tasks with less discomfort
A physical therapist may also be able to recommend certain work accommodations that make it easier for you to do your job. They work at places like hospitals, outpatient clinics, nursing centers, and gyms. If you have health insurance, it’s a good idea to find out if your plan covers some or all of the cost of physical therapy before you start.
Can Lifestyle Changes Make a Difference?
Yes. Eat healthy, get exercise, and do gentle stretches, Bose says. Rest when you need to.
A Mediterranean diet filled with fruits, veggies, whole grains, and healthy fats can help control the inflammation of RA.
It may seem odd, but exercise can also help ease your pain. Talk to your doctor or physical therapist before you start working out. They can recommend exercises and stretches that are safe for you. Ask them to suggest a mix of activities that improve your flexibility, range of motion, endurance, and strength.
Avoid high-impact or heavy exercises that could strain or injure your shoulders, Bose says.