Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Arthritis Research & Therapy
Published in: Arthritis Research & Therapy 1/2015

Open Access 01-12-2015 | Research article

Significantly impaired shoulder function in the first years of rheumatoid arthritis: a controlled study

Authors: Annelie Bilberg, Tomas Bremell, Istvan Balogh, Kaisa Mannerkorpi

Published in: Arthritis Research & Therapy | Issue 1/2015

Login to get access

Abstract

Introduction

Patients with rheumatoid arthritis (RA) risk impaired shoulder function due to the inflammatory process. The knowledge of shoulder function in the early years of the disease is limited. The aim was to compare shoulder function and activity limitation related to the shoulder-arm-hand in women with RA in early disease course compared to age-matched healthy women.

Method

This controlled cross-sectional study included 103 women with rheumatoid arthritis and a reference group of 103 age-matched healthy women. The mean age was 47.1 (SD 10.0) years, the mean disease duration was 20.3 (SD 8.5) months and the mean DAS28 score was 3.8 (SD 1.4) among the patients. Participants were provided with self-reported questionnaires quantifying activity limitations. Shoulder function was assessed by isometric strength of the shoulder, shoulder-arm movement and shoulder pain. Hand-grip force was assessed and examination was made of tender and swollen joints among the patients.

Results

Patients showed significantly (p < 0.0001) impaired shoulder muscle strength, shoulder-arm movement, and shoulder pain compared to the reference group. Patients shoulder muscle strength was approximately 65 % of the results observed in the reference group. Activity limitations related to the shoulder-arm-hand (DASH) were significantly (p < 0.0001) higher in the patient group compared to the reference group and indicates limitations in daily activities for the patients.

Conclusion

Patients with RA were found to have significantly impaired shoulder function already 1.5 years after disease onset compared to age-matched subjects. Reduced shoulder muscle strength was found to be associated with activity limitations (DASH) implying that screening of the shoulder function, emphasising the shoulder muscle strength, should be initiated from disease onset.
Appendix
Available only for authorised users
Literature
1.
Urwin M, Symmons D, Allison T, Brammah T, Busby H, Roxby M, et al. Estimating the burden of musculoskeletal disorders in the community: the comparative prevalence of symptoms at different anatomical sites, and the relation to social deprivation. Ann Rheum Dis. 1998;57:649–55.PubMedCentralCrossRefPubMed
2.
Rechardt M, Shiri R, Karppinen J, Jula A, Heliovaara M, Viikari-Juntura E. Lifestyle and metabolic factors in relation to shoulder pain and rotator cuff tendinitis: a population-based study. BMC Musculoskelet Disord. 2010;11:165.PubMedCentralCrossRefPubMed
3.
Luime JJ, Koes BW, Hendriksen IJ, Burdorf A, Verhagen AP, Miedema HS, et al. Prevalence and incidence of shoulder pain in the general population; a systematic review. Scand J Rheumatol. 2004;33:73–81.CrossRefPubMed
4.
Bostrom C, Harms-Ringdahl K, Nordemar R. Relationships between measurements of impairment, disability, pain, and disease activity in rheumatoid arthritis patients with shoulder problems. Scand J Rheumatol. 1995;24:352–9.CrossRefPubMed
5.
6.
Bilberg A, Bremell T, Mannerkorpi K. Disability of the Arm, Shoulder and Hand questionnaire in Swedish patients with rheumatoid arthritis: A validity study. J Rehabil Med. 2012;44:7–11.CrossRefPubMed
7.
Bostrom C. Shoulder rotational strength, movement, pain and joint tenderness as indicators of upper-extremity activity limitation in moderate rheumatoid arthritis. Scand J Rehabil Med. 2000;32:134–9.CrossRefPubMed
8.
Stegbauer J, Rump LC, Weiner SM. Sites of inflammation in painful rheumatoid shoulder assessed by musculoskeletal ultrasound and power Doppler sonography. Rheumatol Int. 2008;28:459–65.CrossRefPubMed
9.
van de Sande MAJ, de Groot JH, Rozing PM. Clinical implications of rotator cuff degeneration in the rheumatic shoulder. Arthritis Rheum. 2008;59:317–24.CrossRefPubMed
10.
Lehtinen JT, Kaarela K, Belt EA, Kautiainen HJ, Kauppi MJ, Lehto MU. Incidence of glenohumeral joint involvement in seropositive rheumatoid arthritis. A 15 year endpoint study. J Rheumatol. 2000;27:347–50.PubMed
11.
van Schaardenburg D. Rheumatoid arthritis in the elderly. Prevalence and optimal management. Drugs Aging. 1995;7:30–7.CrossRefPubMed
12.
Deal CL, Meenan RF, Goldenberg DL, Anderson JJ, Sack B, Pastan RS, et al. The clinical features of elderly-onset rheumatoid arthritis. A comparison with younger-onset disease of similar duration. Arthritis Rheum. 1985;28:987–94.CrossRefPubMed
13.
Olofsson Y, Book C, Jacobsson LT. Shoulder joint involvement in patients with newly diagnosed rheumatoid arthritis. Prevalence and associations. Scand J Rheumatol. 2003;32:25–32.CrossRefPubMed
14.
Bilberg A, Bremell T, Balogh I, Mannerkorpi K. Work status in patients with early rheumatoid arthritis: emphasis on shoulder function and mechanical exposure. Scand J Rheumatol. 2014;3:119–23.CrossRef
15.
Hallert E, Thyberg I, Hass U, Skargren E, Skogh T. Comparison between women and men with recent onset rheumatoid arthritis of disease activity and functional ability over two years (the TIRA project). Ann Rheum Dis. 2003;62:667–70.PubMedCentralCrossRefPubMed
16.
Rantalaiho V, Kautiainen H, Virta L, Korpela M, Mottonen T, Puolakka K. Trends in treatment strategies and the usage of different disease-modifying anti-rheumatic drugs in early rheumatoid arthritis in Finland. Results from a nationwide register in 2000–2007. Scand J Rheumatol. 2011;40:16–21.CrossRefPubMed
17.
Bergman S, Herrstrom P, Hogstrom K, Petersson IF, Svensson B, Jacobsson LT. Chronic musculoskeletal pain, prevalence rates, and sociodemographic associations in a Swedish population study. J Rheumatol. 2001;28:1369–77.PubMed
18.
Leggin BG, Neuman RM, Iannotti JP, Williams GR, Thompson EC. Intrarater and interrater reliability of three isometric dynamometers in assessing shoulder strength. J Shoulder Elbow Surg. 1996;5:18–24.CrossRefPubMed
19.
Klintberg IH, Svantesson U, Karlsson J. Long-term patient satisfaction and functional outcome 8-11 years after subacromial decompression. Knee Surg Sports Traumatol Arthrosc. 2010;18:394–403.CrossRefPubMed
20.
Bostrom C, Harms-Ringdahl K, Karreskog H, Nordemar R. Effects of static and dynamic shoulder rotator exercises in women with rheumatoid arthritis: a randomised comparison of impairment, disability, handicap, and health. Scand J Rheumatol. 1998;27:281–90.CrossRefPubMed
21.
Borg GA. Psychophysical bases of perceived exertion. Med Sci Sports Exerc. 1982;14:377–81.PubMed
22.
Nordenskiöld U. Elastic wrist orthoses. Reduction of pain and increase in grip force for women with rheumatoid arthritis. Arthr Care Res. 1990;3:158–62.CrossRef
23.
Nordenskiöld UM, Grimby G. Grip force in patients with rheumatoid arthritis and fibromyalgia and in healthy subjects. A study with the Grippit instrument. Scand J Rheumatol. 1993;22:14–9.CrossRefPubMed
24.
Hudak PL, Amadio PC, Bombardier C. Development of an upper extremity outcome measure: the DASH (disabilities of the arm, shoulder and hand) [corrected]. The Upper Extremity Collaborative Group (UECG). Am J Ind Med. 1996;29:602–8.CrossRefPubMed
25.
Atroshi I, Gummesson C, Andersson B, Dahlgren E, Johansson A. The disabilities of the arm, shoulder and hand (DASH) outcome questionnaire: reliability and validity of the Swedish version evaluated in 176 patients. Acta Orthop Scand. 2000;71:613–8.CrossRefPubMed
26.
Hunsaker FG, Cioffi DA, Amadio PC, Wright JG, Caughlin B. The American academy of orthopaedic surgeons outcomes instruments: normative values from the general population. J Bone Joint Surg Am. 2002;84-A:208–15.PubMed
27.
Fries JF, Spitz P, Kraines RG, Holman HR. Measurement of patient outcome in arthritis. Arthritis Rheum. 1980;23:137–45.CrossRefPubMed
28.
Ekdahl C, Eberhardt K, Andersson SI, Svensson B. Assessing disability in patients with rheumatoid arthritis. Use of a Swedish version of the Stanford Health Assessment Questionnaire. Scand J Rheumatol. 1988;17:263–71.CrossRefPubMed
29.
Prevoo ML, van’t Hof MA, Kuper HH, van Leeuwen MA, van de Putte LB, van Riel PL. Modified disease activity scores that include twenty-eight-joint counts. Development and validation in a prospective longitudinal study of patients with rheumatoid arthritis. Arthritis Rheum. 1995;38:44–8.CrossRefPubMed
30.
Larsson B, Balogh I. Is there a relationship between fibromyalgia syndrome and work conditions? J Musculoskelatal Pain. 2005;13:5–14.CrossRef
31.
Mannerkorpi K, Hernelid C. Leisure time physical activity instrument and physical activity at home and work instrument. Development, face validity, construct validity and test-retest reliability for subjects with fibromyalgia. Disabil Rehabil. 2005;27:695–701.CrossRefPubMed
32.
Ekdahl C, Broman G. Muscle strength, endurance, and aerobic capacity in rheumatoid arthritis: a comparative study with healthy subjects. Ann Rheum Dis. 1992;51:35–40.PubMedCentralCrossRefPubMed
33.
Ekblom B, Lovgren O, Alderin M, Fridstrom M, Satterstrom G. Physical performance in patients with rheumatoid arthritis. Scand J Rheumatol. 1974;3:121–5.CrossRefPubMed
34.
Welsing PM, van Gestel AM, Swinkels HL, Kiemeney LA, van Riel PL. The relationship between disease activity, joint destruction, and functional capacity over the course of rheumatoid arthritis. Arthritis Rheum. 2001;44:2009–17.CrossRefPubMed
35.
Guillemin F, Briancon S, Pourel J. Functional disability in rheumatoid arthritis: two different models in early and established disease. J Rheumatol. 1992;19:366–9.PubMed
36.
Schiottz-Christensen B, Lyngberg K, Keiding N, Ebling AH, Danneskiold-Samsoe B, Bartels EM. Use of isokinetic muscle strength as a measure of severity of rheumatoid arthritis: a comparison of this assessment method for RA with other assessment methods for the disease. Clin Rheumatol. 2001;20:423–7.CrossRefPubMed
37.
Stucki G, Bruhlmann P, Stucki S, Michel BA. Isometric muscle strength is an indicator of self-reported physical functional disability in patients with rheumatoid arthritis. Br J Rheumatol. 1998;37:643–8.CrossRefPubMed
38.
Kim HM, Teefey SA, Zelig A, Galatz LM, Keener JD, Yamaguchi K. Shoulder strength in asymptomatic individuals with intact compared with torn rotator cuffs. J Bone Joint Surg Am. 2009;91:289–96.PubMedCentralCrossRefPubMed
39.
Hakkinen A, Hannonen P, Hakkinen K. Muscle strength in healthy people and in patients suffering from recent-onset inflammatory arthritis. Br J Rheumatol. 1995;34:355–60.CrossRefPubMed
40.
Bohannon RW. Hand-grip dynamometry provides a valid indication of upper extremity strength impairment in home care patients. J Hand Ther. 1998;11:258–60.CrossRefPubMed
41.
Bruce B, Fries JF. The Health Assessment Questionnaire (HAQ). Clin Exp Rheumatol. 2005;23:S14–8.PubMed
42.
Larsson B, Sogaard K, Rosendal L. Work related neck-shoulder pain: a review on magnitude, risk factors, biochemical characteristics, clinical picture and preventive interventions. Best Pract Res Clin Rheumatol. 2007;21:447–63.CrossRefPubMed
43.
Ostergren PO, Hanson BS, Balogh I, Ektor-Andersen J, Isacsson A, Orbaek P, et al. Incidence of shoulder and neck pain in a working population: effect modification between mechanical and psychosocial exposures at work? Results from a one year follow up of the Malmo shoulder and neck study cohort. J Epidemiol Community Health. 2005;59:721–8.PubMedCentralCrossRefPubMed
44.
Bergstrom U, Jacobsson LT, Nilsson JA, Wirfalt E, Turesson C. Smoking, low formal level of education, alcohol consumption, and the risk of rheumatoid arthritis. Scand J Rheumatol. 2013;42:123–30.CrossRefPubMed
45.
Neovius M, Simard JF, Askling J. How large are the productivity losses in contemporary patients with RA, and how soon in relation to diagnosis do they develop? Ann Rheum Dis. 2011;70:1010–5.CrossRefPubMed
46.
Barrett EM, Scott DG, Wiles NJ, Symmons DP. The impact of rheumatoid arthritis on employment status in the early years of disease: a UK community-based study. Rheumatology (Oxford). 2000;39:1403–9.CrossRef
47.
Munsterman T, Takken T, Wittink H. Are persons with rheumatoid arthritis deconditioned? A review of physical activity and aerobic capacity. BMC Musculoskelet Disord. 2012;13:202.PubMedCentralCrossRefPubMed
48.
Metadata
Title
Significantly impaired shoulder function in the first years of rheumatoid arthritis: a controlled study
Authors
Annelie Bilberg
Tomas Bremell
Istvan Balogh
Kaisa Mannerkorpi
Publication date
01-12-2015
Publisher
BioMed Central
Published in
Arthritis Research & Therapy / Issue 1/2015
Electronic ISSN: 1478-6362
DOI
https://doi.org/10.1186/s13075-015-0777-0

Other articles of this Issue 1/2015

Arthritis Research & Therapy 1/2015 Go to the issue

Research article

Effects of exercise on depression in adults with arthritis: a systematic review with meta-analysis of randomized controlled trials

Research article

Head-to-head comparison of the safety of tocilizumab and tumor necrosis factor inhibitors in rheumatoid arthritis patients (RA) in clinical practice: results from the registry of Japanese RA patients on biologics for long-term safety (REAL) registry

Research article

Autoantigen microarrays reveal autoantibodies associated with proliferative nephritis and active disease in pediatric systemic lupus erythematosus

Research article

An HLA-C amino-acid variant in addition to HLA-B*27 confers risk for ankylosing spondylitis in the Korean population

Research article

Blockade of bone morphogenetic protein signaling potentiates the pro-inflammatory phenotype induced by interleukin-17 and tumor necrosis factor-α combination in rheumatoid synoviocytes

Research article

Long-lived plasma cells are early and constantly generated in New Zealand Black/New Zealand White F1 mice and their therapeutic depletion requires a combined targeting of autoreactive plasma cells and their precursors
Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Reserve your place

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin
Prof. Florian Limbourg
Prof. Anoop Chauhan
Developed by: Springer Medicine
Obesity Clinical Trial Summary

At a glance: The STEP trials

Read more

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Pediatric Cardiology Video

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

Cardiopulmonary Comorbidity Video

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Valvular Heart Disease Video

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.

Watch now

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

16-04-2024 Type 2 Diabetes News

Incentivised to exercise

11-04-2024 Lifestyle Modifications News

New intervention for STEMI-related cardiogenic shock

10-04-2024 Myocardial Infarction News

» View more highlights on the ACC 2024 congress hub page

Image Credits