A Swiss cohort study found that patients with rheumatoid arthritis who underwent shoulder arthroplasty experienced significant improvements in pain and shoulder function; emotional changes also influenced pain outcomes.
Patients who reported reduced negative affect six months after surgery had a stronger association between functional improvement and pain relief.
The study analyzed data from 92 patients with rheumatoid arthritis (RA) who had either reverse or anatomic total shoulder arthroplasty. Of these, 80% were women, and the mean age was 65 years (SD, 11.1). Pain was measured using a Numeric Rating Scale (0–10), and shoulder function was assessed using the Shoulder Pain and Disability Index (SPADI). Emotional status was measured using the negative affect subscale from a validated quality of life instrument.
At baseline, the mean pain score was 5.6 (SD, 2.6), which decreased to 1.2 (SD, 1.7) at 6 months postoperatively (P < .001). SPADI scores improved from 63.7 (SD, 18.7) to 24.7 (SD, 15.9) (P < .001). Negative affect scores declined slightly from 1.4 (SD, 0.7) to 1.2 (SD, 0.4), but this change did not reach statistical significance (P = .067).
Moderation analysis revealed that greater improvement in shoulder function was associated with greater pain reduction (β = 0.06; P = .018). Reductions in negative affect were linked to better pain outcomes (β = −1.76; P = .037). A significant interaction between functional improvement and negative affect change (β = 0.16; P = .017) indicated that the effect of functional gains on pain relief was amplified in patients who also experienced improved emotional states.
Persistent postsurgical pain, defined as a score of 3 or higher at follow-up, was reported in 16% of patients. Among procedures performed, 72% were reverse shoulder arthroplasties and 28% were anatomic. Arthroplasty occurred on the dominant side in 56% of patients. Rotator cuff status varied, with 31% showing massive tears and 19% having intact cuffs. Mean surgery duration was 98.5 minutes (SD, 26.4), and 30% underwent biceps tenotomy.
Data were collected through a local shoulder arthroplasty registry. Patients undergoing revision procedures were excluded. All assessments were self-reported.
Although the overall change in negative affect was small, its role as a moderator in pain outcomes was significant. The findings support consideration of emotional well-being in recovery planning for RA patients undergoing shoulder arthroplasty.
While the study had limitations, including reliance on self-reported data, small sample size, and a follow-up limited to 6 months, these results suggest that postoperative pain relief may depend not only on physical recovery but also on changes in emotional state during rehabilitation. Other psychological variables such as coping strategies, depression, or therapy adherence were not evaluated, but may also influence recovery. Integrating emotional health into recovery plans may improve outcomes for this patient population.
Full disclosures can be found in the published study.
