Shoulder destruction in rheumatoid arthritis. Classification and prognostic signs in 83 patients followed 5-23 years.

We studied the natural course and the possibility of making prognoses about shoulder joint destructions in 83 patients with rheumatoid arthritis (RA) (166 shoulder joints). For this purpose, we used radiographic patterns and 2 indices (upward migration and medial displacement). The patterns of joint destruction were classified into 5 groups: 1) non-progressive type (n 74) with normal radiographs, only osteopenia or small erosions even after 15-20 years of RA; 2) erosive type (n 22) showing marginal erosions but no collapse; 3) collapse type (n 34) showing subchondral cysts, followed by collapse; 4) arthrosis-like type (n 12) showing arthrotic features; 5) mutilating type (n 14) showing mutilating bone destructions. From the radiographic findings and the 2 indices determined at 5-10 years, we could predict the prognosis of shoulder joint destruction after 15-20 years of RA. Our findings may be of value for selecting treatment, including surgery, for the rheumatoid shoulder.