Plain language summary
Surgery for rheumatoid arthritis in the shoulder
This summary of a Cochrane review presents what we know from research about the effect of one type of surgery for rheumatoid arthritis (RA) in the shoulder. Currently, there is a very limited amount of research on the effect of surgical treatments for the shoulder in people with RA.
In this review the researchers were able to find just one study comparing one form of surgery called “augmented subscapularis transposition” to another involving just “subscapularis transposition”.
The review shows that in people with rheumatoid arthritis in the shoulder; a surgery involving Augmented subscapularis transposition:
· may improve your physical function slightly compared to subscapularis transposition alone.
· makes no difference in improving your pain compared to subscapularis transposition alone.
Infections were not reported.
We often do not have precise information about side effects and complications. This is particularly true for rare but serious side effects.
What is rheumatoid arthritis and what kind of surgery have been tried?
Rheumatoid arthritis is a disease in which the body's immune system attacks the lining of the joints, and the joints become swollen, stiff and painful. Usually, the joints of the hands and feet are affected first, but many people with rheumatoid arthritis are severely affected in their shoulders. There is no cure for RA at present, so treatments aim to relieve pain and stiffness, and improve the ability to move.
One common shoulder surgical treatment for people with RA is arthroplasty, i.e. the joint surface (and bone) is replaced with prosthesis (an artifical joint).
Best estimate of what happens to people with rheumatoid arthritis who have the type of shoulder surgery called “augmented subscapularis transposition”:
People with Augmented subscapularis transposition rated their physical function to be 4 points better on a scale of 0-20 after 2 years compared to people who had augmented subscapularis alone. (8% absolute improvement)
People with subscapularis transposition alone rated their physical function to be 11 points out of 20.
People with Augmented subscapularis transposition rated their physical function to be 15 points out of 20.
治療類風濕肩關節炎之手術：從本篇Cochrane的文獻回顧中我們得知用於治療類風濕關節炎肩膀的手術效果。目前，關於這方面的研究數量相當有限。在此篇回顧文章中，研究者發現只有1篇文章比較了稱為增強肩胛下肌轉位對肩胛下肌轉位的手術結果。文中顯示了前者可以稍微改善患者的生理功能，但對疼痛的改善則無差異。沒有關於感染的結果。且大多沒有關於併發症的正確資訊，特別是罕見但嚴重的併發症。何謂類風濕關節炎？又曾使用過哪些手術？類風濕關節炎是一種自體的免疫系統攻擊關節表面的疾病，因此關節變的腫脹、僵硬且相當疼痛。一般而言，手和足部的關節最先受到侵犯，但多數患者的肩膀會受到嚴重的侵犯。現今仍無法治癒類風濕關節炎，因此治療目標為緩解關節疼痛和僵硬，並增加關節的運動能力。此類患者常用來治療肩關節的一種手術方式為關節置換術，也就是說關節表面（和骨頭）以假體（人工關節）來取代。評估接受增強肩胛下肌轉位手術的類風濕關節炎患者最好的方法是：功能。在術後兩年以0–20的量表評估自己的生理功能，發現接受增強肩胛下肌轉位手術的患者，較僅接受增強肩胛下肌手術的患者高出4分（8%有顯著的進步; absolute improvement）。僅接受肩胛下肌轉位手術的患者則評其生理功能為11分；而接受增強肩胛下肌手術的患者則評為15分。