Rotator cuff tendinopathy is associated with increased activity score in rheumatoid arthritis

Introduction and objective

Rheumatoid arthritis (RA) is often accompanied by musculoskeletal (MS) symptoms, which can hinder the diagnosis of concurrent conditions like rotator cuff tendinopathy (RCT), the most common cause of shoulder pain. Undiagnosed RCT in patients with RA may be associated with higher disease activity scores. This study aimed to assess the difference in these scores between RA patients with and without RCT, considering ultrasound pathological findings.

Methods

We conducted a cross-sectional, observational, comparative study in patients with shoulder pain who met the 2010 ACR-EULAR classification criteria for RA between January 2022 and January 2023. The measurements of Disease Activity Score based on 28 joints using C-Reactive Protein (DAS28-CRP), Erythrocyte Sedimentation Rate (DAS28-ESR), and the Clinical Disease Activity Index (CDAI) were used to evaluate RA activity, while functional capacity was assessed using the Health Assessment Questionnaire Disability Index (HAQ-DI). The Disabilities of the Arm, Shoulder, and Hand questionnaire (DASHe) and shoulder ultrasound examination was performed to detect the presence or absence of RCT.

Results

Patients with RCT had greater mean scores on DAS28-CRP (5.23, 1.28 vs. 3.08, p < 0.001), and DAS 28-ESR (5.43, SD = 1.28 vs. 3.66, p < 0.001). VAS median scores were higher in the RCT group (70.00 vs. 2.00, p < 0.001). By ultrasound 12 patients (21%) had acromioclavicular synovitis. Glenohumeral and acromioclavicular arthrosis was found in both groups. No patients had arthritis in the glenohumeral joint.

Conclusion

RA patients with RCT have higher composite index and disease activity scores than those without RCT. An intentional RCT screening should be recommended for those with shoulder pain and elevated disease activity.