My shoulders were intensely painful when my RA began. Shoulder involvement is common when RA begins in older age, EORA.  Elderly onset rheumatoid arthritis is also a rheumatoid arthritis that is more painful and destructive.

The shoulder is made up of the clavicle in the front, the scapula in the back, and the head of the upper arm bone, the humerus. The socket is shallow unlike the deep hip socket. This creates a big, flexible joint that can move in many directions. It is a ball and socket joint called glenohumeral joint. We can feel it when we lift our arm. It is also an unstable joint. The rotator cuff, a group of muscles and their tendons, stabilize the joint.

• The shoulder joint is lined with synovial tissue.
• Bursae, also lined with synovial tissue, help protect the bones and tendons.
• Add to this, the tendons are protected with synovial lined sleeves.

All this synovial tissue is a target for rheumatoid arthritis.

Add to this, the shoulder has a second joint called the acromioclavicular joint. This joint connects the clavicle with the tip of the scapula. It is a plane synovial joint where its motion is restricted to gliding.

Rheumatoid arthritis is a likely cause for several shoulder disorders. Rotator cuff degeneration is one. Frozen shoulder is another. Bursitis is one more.

These conditions add to the inflammation, pain and immobility of rheumatoid arthritis. I have a difficult time changing shirts. Its very painful. To get the shirt off, I slip my hand under my shirt to the  under-arm part of the shirt, grip the sleeve and then slide it off. I repeat with the other arm. I bend and slip the shirt over my head.

Sleeping can be difficult and painful with inflamed shoulders. I sleep on my side. I have two pillows on each side of my bed. I pull them down so that my shoulders are near the pillows but not on them.

I also use a mattress pad warmer, a long-ago suggestion from my sister-in-law Cathy. It helps. It feels especially cozy in the wee hours of the morning when the RA pain is starting to rachet up.

We often think of the fingers and toes when we think of rheumatoid arthritis. Shoulder involvement is incapacitating and painful. It occurs more often in advanced cases of RA. It also occurs when RA is diagnosed in older age.