This is my first post...I am 66 years old, have had OA for many years but was diagnosed 18 months ago with Sero negative RA and am now on a good cocktail of mtx, folic acid, naproxen. Paracetamol, Enbrel, Bu Trans patches and Hydroxychloroquine. The RA is now quite well controlled although I do need occasional steroid injections and am about to have injections into both shoulders. I do Pilates and aqua fit classes as often as possible but now I can't raise my arms higher than chest level and the pain is pretty bad, keeping me awake most nights. My concern is what next if these injections don't work? It seems joint replacement could be the next step so I am wondering whether anyone else has had to go down this path and how bad their shoulders were before the decision was made....and how successful the operation was. I'm seeing my Rheumy next month for a review but also this month for the injections. I have to say I think I am so lucky and must have the best, most supportive RA team in the world so I am not complaining, just getting a bit fed up with still being in constant pain despite all the meds. However, up to the point of diagnosis I could hardly walk, so upwards and onwards eh? Thank you....this site has been so useful and supportive.