From the Guidelines
Glenohumeral joint synovitis in rheumatoid arthritis should be managed with a comprehensive approach, prioritizing disease-modifying antirheumatic drugs (DMARDs) such as methotrexate, as recommended by the 2019 EULAR update 1.
Key Considerations
- The primary goal of treatment is to achieve sustained remission or low disease activity, with monitoring every 1-3 months and adjustments made as necessary 1.
- Methotrexate should be part of the first treatment strategy, unless contraindicated, and can be combined with other csDMARDs or bDMARDs if needed 1.
- Short-term glucocorticoids can be used to manage acute flares, but should be tapered as rapidly as clinically feasible 1.
- Non-pharmacological interventions, such as physical therapy and patient education, should also be considered as adjuncts to drug treatment 1.
Treatment Approach
- Initial management should include DMARDs, such as methotrexate, to slow disease progression, along with NSAIDs for pain and inflammation.
- For acute flares, corticosteroid injections into the joint can provide temporary relief.
- Physical therapy focusing on gentle range-of-motion exercises and strengthening of the rotator cuff muscles is essential to maintain function and prevent contractures.
- Patients should also use heat therapy before exercise and cold therapy after activity to manage pain.
- If conservative measures fail, surgical options including synovectomy or total shoulder arthroplasty may be considered.
Important Considerations
- Early aggressive treatment is crucial to prevent permanent joint damage and maintain shoulder function.
- The treatment approach should be individualized, taking into account the patient's specific needs and circumstances.
- Regular monitoring of disease activity, adverse events, and comorbidities should guide decisions on choice and changes in treatment strategies 1.
From the Research
Glenohumeral Joint Synovitis in Rheumatoid Arthritis
- Rheumatoid arthritis (RA) is a systemic autoimmune disease characterized by chronic inflammation and progressive deterioration of the joints, which generates pain and stiffness 2.
- The management of RA requires a multidisciplinary approach, and good RA management can reduce disease activity and prevent systemic complications 3.
- Disease-modifying anti-rheumatic drugs (DMARDs) are the most promising treatment for RA, and they can be classified into conventional synthetic, biologic, and targeted synthetic drugs 4, 5, 3.
- Early diagnosis and treatment of RA can avert or substantially slow progression of joint damage in up to 90% of patients, thereby preventing irreversible disability 5.
- The treatment target for RA is remission or a state of at least low disease activity, which should be attained within 6 months 5.
Treatment Options for Glenohumeral Joint Synovitis in RA
- DMARDs are the fundamental basis of treatment for RA, since the main mechanism of pain in this entity is inflammation 2.
- Medications such as NSAIDs, topical capsaicin, weak opioids, and treatments such as joint infiltrations or surgical management, play an important role in the management of pain in RA 2.
- Glucocorticoids can be used in combination with DMARDs to achieve analgesia in RA 2.
- However, there is limited evidence for the use of other pharmacological groups such as neuromodulators, antidepressants, muscle relaxants, and cannabinoids in the management of RA 2.
Management of Glenohumeral Joint Synovitis in RA
- The management of glenohumeral joint synovitis in RA is not specifically addressed in the available evidence, as most studies focus on the management of osteoarthritis or RA in general 6.
- However, the principles of RA management, including early diagnosis, treatment with DMARDs, and a multidisciplinary approach, can be applied to the management of glenohumeral joint synovitis in RA 4, 5, 3.