Reverse Total Shoulder Arthroplasty in a 25-Year-Old Woman With Seropositive Rheumatoid Arthritis After Prior Age-Based Surgical Deferral.

Reverse total shoulder arthroplasty (RTSA) in very young adults with rheumatoid arthritis (RA) is uncommon because of concerns regarding implant longevity and lifetime revision burden, and outcomes data in patients younger than 30 years remain limited. We report the case of a 25-year-old woman with seropositive RA who developed rapid, destructive monoarticular involvement of the right shoulder despite treatment with disease-modifying antirheumatic drugs (DMARDs) and biologic therapy. Imaging demonstrated complete glenohumeral joint space obliteration, humeral head collapse, erosive changes, and rotator cuff insufficiency. An initial shoulder surgeon declined arthroplasty based on her age and anticipated revision risk. Following staged diagnostic arthroscopy, definitive RTSA was performed in December 2023 without complication. At four months, near-full active forward elevation was restored. At two-year follow-up, the American Shoulder and Elbow Surgeons (ASES) score was 80/100 (pain 3/10; activities of daily living 27/30), and the Single Assessment Numeric Evaluation (SANE) score was 95%. No instability, infection, or mechanical failure occurred. This case demonstrates that RTSA can provide excellent early and mid-term functional outcomes in carefully selected very young patients with end-stage inflammatory shoulder disease and may help inform surgical decision-making when age is the primary barrier to intervention.