A recent study published in Reumatología Clínica has found that rheumatoid arthritis (RA) patients with rotator cuff tendinopathy exhibit significantly higher disease activity compared to those without this concurrent shoulder condition.
The cross-sectional, observational study included RA patients with shoulder pain who met the 2010 ACR-EULAR classification criteria between January 2022 and January 2023. The researchers aimed to evaluate differences in disease activity scores between patients with and without rotator cuff tendinopathy, incorporating ultrasound findings into the assessment. Disease activity was measured using DAS28-CRP, DAS28-ESR, and the Clinical Disease Activity Index, while functional capacity was assessed with the Health Assessment Questionnaire Disability Index. Patients also completed the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, and shoulder ultrasounds were performed to confirm the presence of rotator cuff tendinopathy.
The study revealed substantially higher disease activity in patients with rotator cuff tendinopathy. DAS28-CRP scores averaged 5.23 (SD=1.28) compared to 3.08 in patients without the condition (p<0.001), and DAS28-ESR scores were 5.43 (SD=1.28) versus 3.66 (p<0.001). Visual analog scale (VAS) scores were also markedly elevated in the tendinopathy group, with a median of 70.00 versus 2.00 (p<0.001). Ultrasound detected acromioclavicular synovitis in 12 patients (21%), while both groups showed glenohumeral and acromioclavicular arthrosis, although no glenohumeral arthritis was observed.
Rotator cuff tendinopathy affects the tendons of the shoulder’s rotator cuff, causing degeneration, inflammation, or microtears, often due to overuse, aging, or repetitive movements. Common risk factors include overhead activities, trauma, tendon degeneration, and systemic conditions such as RA, which can exacerbate tendon inflammation. Patients typically experience pain at the top and outside of the shoulder, weakness in lifting or rotating the arm, restricted motion, and localized tenderness. Diagnosis relies on clinical tests, such as the painful arc and drop arm tests, and is often confirmed using ultrasound or MRI. In RA patients, rotator cuff tendinopathy can worsen pain and functional limitations and is associated with higher disease activity scores, highlighting the need for early detection and targeted management.
Similar findings were reported by a six-year retrospective cohort study in Taiwan, which included 4,521 RA patients and 22,605 matched controls. The study found a higher incidence of rotator cuff disease (145 versus 91 per 100,000 person-years) in RA patients, with an adjusted hazard ratio of 1.56 (95% CI, 1.36–1.79; p<0.001). Use of methotrexate or steroids was associated with a reduced risk of developing rotator cuff disease.
These findings emphasize the importance of recognizing periarticular involvement in RA and underscore the need for targeted screening and management strategies to ensure comprehensive, high-quality patient care.
References
- Medina-Castillo J, Castillo-de la Garza RJ, Vega-Morales D, Esquivel-Valerio JA, De León-Pérez AA, De La Cruz-Becerra L, Montoya-Montes AE, Gil-Flores L, Galarza-Delgado DÁ. Rotator cuff tendinopathy is associated with increased activity score in rheumatoid arthritis. Reumatol Clin (Engl Ed). 2025 Oct;21(8):501947.
- Wang WT, Huang SW, Liou TH, Lin HW. Patients with Rheumatoid Arthritis Were Associated with a Risk of Rotator Cuff Diseases. J Clin Med. 2019 Jan 22;8(2):129.