Review of Treatment Choices for Rheumatoid Arthritis Affecting the Elbow

This review article brings us up to date on treatment for the arthritic elbow. Up to half of all patients with rheumatoid arthritis (RA) will have elbow problems. Pain, swelling, and loss of motion in the elbow also affect the hand and shoulder. Patients who also have shoulder problems have an even bigger challenge.

Treatment begins with physical and occupational therapy. The goal is to reduce pain and keep as much motion as possible for as long as possible. Therapists teach patients ways to prevent damage to the joint and nearby tendons and ligaments.

If the disease continues to get worse, surgery may be needed. At first, the doctor may remove part or all of the synovium, the lining of the joint. This operation is called a synovectomy. If synovectomy doesn't help, the joint may need to be replaced. Rarely, the elbow joint may be surgically fused in place.

Some doctors say treating the shoulder first puts less stress on the elbow. Treating the shoulder first will also decrease any pain from the shoulder affecting the elbow. Others advise elbow surgery first, as this can give more use of the arm right away.

Elbow joint replacement may be needed for some patients with advanced rheumatic elbow disease. New and improved implants and operating techniques make this a good option for patients who put low demand and use on the elbow. Patients who are more active may be at risk for implant loosening and wear.

The authors conclude that early management of elbow arthritis is important. The patient can maintain motion and function for as long as possible before needing surgery. Joint replacement for the elbow is fast-becoming as good as hip and knee replacements in patients with RA.

References: Jeffrey I. Kauffman, MD, et al. Surgical Management of the Rheumatoid Elbow. In Journal of the American Academy of Orthopaedic Surgeons. March/April 2003. Vol. 11. No. 2. Pp. 100-108.