title: Significantly impaired shoulder function in the first years of rheumatoid arthritis: a controlled study.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Institute of Medicine, Department of Rheumatology and Inflammation Research, Sahlgrenska Academy, University of Gothenburg, Guldhedsgatan 10, Box 480, 40530, Göteborg, Sweden. annelie.bilberg@vgregion.se.
authors.forename: Annelie
authors.initials: A
authors.lastname: Bilberg
authors.affiliation: Institute of Medicine, Department of Rheumatology and Inflammation Research, Sahlgrenska Academy, University of Gothenburg, Guldhedsgatan 10, Box 480, 40530, Göteborg, Sweden. tomas.bremell@vgregion.se.
authors.forename: Tomas
authors.initials: T
authors.lastname: Bremell
authors.affiliation: Institute of laboratory Medicine, Department of Occupational and Environmental Medicine, University of Lund, 22185, Lund, Sweden. istvan.balogh@lu.se.
authors.forename: Istvan
authors.initials: I
authors.lastname: Balogh
authors.affiliation: Institute of Medicine, Department of Rheumatology and Inflammation Research, Sahlgrenska Academy, University of Gothenburg, Guldhedsgatan 10, Box 480, 40530, Göteborg, Sweden. kaisa.mannerkorpi@rheuma.gu.se.|Institute of Neuroscience and Physiology, Section of Health and Rehabilitation, Physiotherapy, Sahlgrenska Academy, University of Gothenburg, Box 455, 40530, Göteborg, Sweden. kaisa.mannerkorpi@rheuma.gu.se.
authors.forename: Kaisa
authors.initials: K
authors.lastname: Mannerkorpi
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D001172:Arthritis, Rheumatoid / Q000150:complications*; D003430:Cross-Sectional Studies; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D008875:Middle Aged; D053580:Muscle Strength / Q000502:physiology; D010147:Pain Measurement; D016059:Range of Motion, Articular / Q000502:physiology; D012782:Shoulder; D011795:Surveys and Questionnaires