Shoulder tenderness was associated with the inflammatory changes on magnetic resonance imaging in patients with rheumatoid arthritis

Successful treatment of a rheumatoid arthritis patient with severe synovial hypertrophy and impaired shoulder function with microwave ablation technique

Rheumatoid arthritis (RA) is a chronic, inflammatory systemic disorder of synovial joints and results in polyarthritis, chronical degeneration, and finally deformities and ankylosis in severe cases. Synovitis and pannus formation are results of inflammatory changes and lead into restriction in joint movement. Shoulders are among the later affected and larger joints and formation of synovitis in early active stages and pannus in later stages might be concluded with frozen shoulder and severe impairment in functionality. These late-term changes cannot be controlled with systemic or local anti-inflammatory agents and synovectomy is chosen in some cases. However, the results are not satisfactory and recurrence is common. In this case report, we presented a case of RA with severe shoulder pain, restricted movement due to synovial hypertrophy, and pannus formation which are resistant to local and systemic interventions and not suitable for surgical or chemical synovectomy. Microwave ablation (MWA) was performed successfully without any complication and she well responded in terms of DAS-28, functional, and pain scores. Range of motion and funcitonal restriction were recovered. This case report describes the use and promising results of MWA in RA with severe synovial hypertrophy and pannus formation even in the absence of active arthritis and effusion. MWA is a safe and minimally invasive technique that can be easily performed in coordinance of rheumatologists and interventional radiologists in proper cases.

Orthetik bei rheumatologischen Erkrankungen

Die Versorgung von Patienten mit körpernahen Hilfsmitteln wie Orthesen, Bandagen oder Tapes stellt einen wichtigen Pfeiler der konservativen Maßnahmen der Versorgung von rheumatologischen Erkrankungen dar. Ziel ist es dabei stets schmerzauslösende Belastungen zu reduzieren sowie durch Destruktion instabile Gelenke zu stabilisieren um somit die Funktionsfähigkeit im Alltag so gut es geht aufrecht zu erhalten. Die Teilhabe an täglichen Arbeiten kann dadurch oftmals verbessert werden, was sich konsekutiv auf die Lebensqualität auswirkt. In diesem Beitrag soll die Systematik von verordnungsfähigen Orthesen erklärt werden und anschließend darauf aufbauend für wichtige, oftmals betroffene Gelenke Stabilisationsmöglichkeiten aufgezeigt werden. Die Evidenz und die Verordnungsweise werden dabei wenn möglich aufgezeigt.