In much the same way it intrigues me that no two snowflakes are alike, I find the individuality of RA equally compelling. I also think it can explain why it is so often difficult to treat a disease that presents in so many ways! That may also be partially responsible for the challenge in diagnosing it promptly. Although we also know that the fact that it is largely a clinical diagnosis contributes to this as well.
These variances all weave together to make the RA "quilt" a complicated and nuanced problem. So when one is dealing with RA as I have been for nearly 20 years now, I try to remember this when I am feeling particularly miserable for no apparent reason other than I woke up that day. This past period of time my RA has once again reverted back to how it began with me...in my shoulders. I still remember when researching RA back before I was officially diagnosed, time and again it referred to the fact that in most cases it began in the hands and feet. Not so with me. It started in my hips and shoulders and it was months if not a year later till my hands and feet joined the party.
Once they did they "partied" with a vengeance and still like to "dance the night away" to this day! To the point that I needed some major corrective surgery to my feet (which was very successful). So you would think I would not have been surprised when the shoulders jumped back in the game and to a degree I was not. BUT...I was dreading it! Of all the joints that get inflamed (there are over 350 in the human body) for me the shoulders are, hands down (no pun intended) the absolute most painful. Why? well if you look at the shoulder itself and the function it plays in how we move if might explain this.
Notice the synovium just below the capsule. That is what gets inflamed when you flare with RA and you can see here how much that would influence all the other moving parts of the shoulder. So when my shoulder is flaring the pain goes up and across my shoulder to my neck and back as well as down my arm into my hand. The slightest movement is excruciating, from simply lifting a fork to eat to trying to open a car door, never mind something as "strenuous" as brushing my hair or getting dressed!
So, what is to be done? One thing NOT to do is stop using the shoulder. I know this goes against every instinct that is screaming at you to NOT move it to stop the pain. But if you don't maintain at least a minimal level of ROM (Range of Motion) you could develop frozen shoulder which is even uglier and adds to the difficulty of treating RA shoulder issues.