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The key clinical manifestations of Rheumatic heart disease (RHD) include several distinct cardiac symptoms.Carditis, a hallmark of acute rheumatic fever, involves inflammation of the heart's endocardium, myocardium, and pericardium. Chronic RHD often results from recurrent episodes of carditis. Its symptoms include the following:Murmurs are caused by valvular damage, especially to the mitral and aortic valves. Mitral stenosis or regurgitation is common, with characteristic heart murmurs...
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Reverse Total Shoulder Arthroplasty
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Ultrasonographic Evaluation of Asymptomatic Shoulder Involvement in Rheumatoid Arthritis: A Prospective Case-Control

Yunus Emre Doğan1, Çiğdem Çınar2, Kadriye Öneş3

  • 1Department of Physical Medicine and Rehabilitation, Fatih Sultan Mehmet Training and Research Hospital, University of Health Sciences, 34752 Istanbul, Türkiye.

Journal of Clinical Medicine
|May 27, 2026
PubMed
Summary

Asymptomatic rheumatoid arthritis (RA) patients show increased biceps tendon issues on ultrasound compared to healthy individuals. Subclinical shoulder findings in RA are linked to disease activity, particularly biceps tendinopathy.

Keywords:
biceps tendinopathydisease activityrheumatoid arthritisshouldersubclinical involvementultrasonography

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Area of Science:

  • Rheumatology
  • Orthopedics
  • Radiology

Background:

  • Shoulder involvement is frequent in rheumatoid arthritis (RA), but periarticular pathology can be asymptomatic.
  • Musculoskeletal ultrasonography is valuable for detecting early inflammatory and structural changes in RA.
  • Limited data exists on subclinical shoulder abnormalities in RA patients.

Purpose of the Study:

  • To evaluate ultrasonographic shoulder findings in asymptomatic RA patients.
  • To compare these findings with those in healthy controls.
  • To assess the association between subclinical shoulder pathology and RA disease activity.

Main Methods:

  • A prospective case-control study involving 31 RA patients and 33 healthy controls.
  • Standardized bilateral shoulder ultrasonography, including assessment of periarticular findings (USPRS) and acromiohumeral distance (AHD).
  • Disease activity measured by DAS28; statistical analyses included group comparisons, correlations, ROC, and logistic regression.

Main Results:

  • RA patients had significantly higher biceps tendinopathy scores than controls (p=0.01).
  • No significant differences were found in other ultrasonographic parameters like supraspinatus tendinopathy, dynamic impingement, AHD, or total USPRS score.
  • DAS28 correlated positively with biceps and supraspinatus tendinosis (r=0.37 and r=0.36, respectively); DAS28 was independently associated with biceps tendinopathy (OR=1.62).

Conclusions:

  • Asymptomatic RA patients exhibit a greater burden of biceps tendon involvement compared to healthy individuals.
  • Subclinical shoulder ultrasonographic findings, especially biceps tendinopathy, are associated with RA disease activity.
  • The long head of the biceps tendon may be a sensitive indicator of subclinical periarticular involvement in RA, though overall differences were limited.