title: Ultrasound imaging for the rheumatologist XLVIII. Ultrasound of the shoulders of patients with rheumatoid arthritis.
abstract: OBJECTIVE
  To investigate the prevalence of ultrasonographic (US) shoulder abnormalities in patients with rheumatoid arthritis (RA) and to investigate the relationship between US findings and demographic and clinical features.
  
  
  METHODS
  Consecutive patients attending the rheumatology units involved in this study were enrolled. Clinical and demographical data were recorded. US of bilateral shoulders was performed at the same time, examining tendons, bursae, gleno-humeral and acromion-clavicular joints. The presence of signs of inflammation, bone erosions or rotator cuff pathology was evaluated.
  
  
  RESULTS
  A total of one hundred patients were enrolled, mean age (SD) 59.6 (14.7) years, median disease duration (IQR) 56.5 (34.7, 96.5) months, 98% of them were on DMARDs and 22% on biologics. Shoulder tenderness was reported by 44% of patients. 34% of patients showed at least one sign of inflammatory involvement, and 25% of them presented with humeral head erosions. Signs of rotator cuff pathology were seen in 49% of patients. Agreement between the presence of spontaneous pain and US inflammatory abnormalities was moderate (kappa 0.501). Patients with inflammatory involvement of the shoulders had significantly higher DAS28, HAQ, VAS pain, acute phase reactants and disease duration compared to patient with no inflammatory signs, they were more frequently RF positive and reported more frequently spontaneous pain.
  
  
  CONCLUSIONS
  US assessment of the shoulder in RA patients can be considered of value, especially in patients with relevant indicators of disease activity and severity.
authors.affiliation: Chair and Division of Rheumatology, IRCCS Policlinico San Matteo Foundation, Pavia, Italy. filiciasak@gmail.com.
authors.forename: Garifallia
authors.initials: G
authors.lastname: Sakellariou
authors.forename: Annamaria
authors.initials: A
authors.lastname: Iagnocco
authors.forename: Emilio
authors.initials: E
authors.lastname: Filippucci
authors.forename: Fulvia
authors.initials: F
authors.lastname: Ceccarelli
authors.forename: Luca
authors.initials: L
authors.lastname: Di Geso
authors.forename: Linda
authors.initials: L
authors.lastname: Carli
authors.forename: Lucrezia
authors.initials: L
authors.lastname: Riente
authors.forename: Andrea
authors.initials: A
authors.lastname: Delle Sedie
authors.forename: Carlomaurizio
authors.initials: C
authors.lastname: Montecucco
mesh_terms: D000209:Acute-Phase Proteins / Q000032:analysis; D000328:Adult; D000368:Aged; D018501:Antirheumatic Agents / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000097:blood / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000276:immunology; D015415:Biomarkers / Q000097:blood; D016009:Chi-Square Distribution; D003430:Cross-Sectional Studies; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D018836:Inflammation Mediators / Q000097:blood; D007558:Italy; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D011237:Predictive Value of Tests; D012720:Severity of Illness Index; D012785:Shoulder Joint / Q000000981:diagnostic imaging* / Q000187:drug effects / Q000276:immunology; D020069:Shoulder Pain / Q000000981:diagnostic imaging; D013997:Time Factors; D016896:Treatment Outcome; D014463:Ultrasonography
chemical_list: D000209:Acute-Phase Proteins; D018501:Antirheumatic Agents; D015415:Biomarkers; D018836:Inflammation Mediators