This is kind of a touchy question but how do I know if my doctor is keeping up with the latest treatment of rheumatoid arthritis? I want to make sure I am getting everything possible and necessary to keep this problem in check.


You can try a very direct approach by asking your physician this very question in as tactful a way as possible. Consumers have a right to the most up-to-date services and should be able to ask any of their health care providers how they keep abreast of the latest ideas for the particular problem at hand.

Physicians have at their disposal a variety of ways to keep up with the latest knowledge and understanding of the diseases, illnesses, and conditions they treat. It could be as simple as reading an article on elbow arthritis that has been approved as a continuing education course. Anyone who reads the material and answers the questions correctly can earn continuing education credits. In the process, the reader will gain an understanding of current thinking and orthopedic practice in the treatment of elbow arthritis.

For example, in a recent publication of The Journal of Hand Surgery (March 2013), recent developments in the treatment of elbow arthritis were presented. Learning objectives for the reader included understanding function of the elbow and forearm, causes of elbow arthritis, types of patients who have this condition, and treatment (nonsurgical and surgical) of the problem.

The following is a brief summary of the contents of that article to give you an idea of what crosses physicians’ desks these days just through their professional literature. The review was broken down into two major sections: diagnosis and management. As with all medical conditions, the diagnosis of elbow arthritis requires a careful patient history and clinical examination.

Special tests (neurologic exam, examination of alignment, blood work) and imaging (X-rays, CT scans, or MRIs) are part of the evaluation process. X-rays are usually enough to identify joint damage, loss of joint space, and the presence of bone spurs or any “loose bodies” (fragments of bone or cartilage) inside the joint. More advanced imaging such as CT scans or MRIs are more likely ordered when surgery is being planned.

The physician must differentiate between rheumatoid (inflammatory) arthritis and osteoarthritis (degenerative disease). Recognizing differences in the signs and symptoms and patient history/patient type is important in making this distinction. For example, someone with rheumatoid arthritis of the elbow will have pain and stiffness throughout the full elbow range-of-motion.

A patient with osteoarthritis is more likely to have difficulty at the point of full elbow flexion or elbow extension. Pain through the entire range of elbow motion doesn’t develop with osteoarthritis until the condition is very severe (considered “advanced” disease).

The patient’s history can be very telling. Trauma to the elbow or a history of heavy use of the arm (e.g., weight lifting, construction work, throwing athletes) is linked with osteoarthritis. Patients with rheumatoid arthritis (RA) may have a family history of RA but no history of overuse to suggest osteoarthritis (OA).

The plan of care for anyone with elbow arthritis is to relieve pain and improve or restore function for daily activities. That sounds simple enough but there are many ways to approach this. The first is always with conservative (nonoperative) care. This can include medications, rest, physical therapy, and modification of activities. Treatment of osteoarthritis in manual laborers can be more challenging as they are unable to stop working or even change the way they use the arm because of the job requirements.

In the case of rheumatoid arthritis (RA), 10 per cent of patients will get full recovery with early diagnosis and aggressive treatment with disease modifying anti-rheumatic drugs (DMARDs) and other biologic therapies. Surgery for elbow arthritis is only recommended when patients fail to improve with nonsurgical care. Surgical options include synovectomy, arthroscopic debridement, and joint replacement (called arthroplasty).

The choice of which surgical procedure to perform depends on whether the condition is inflammatory (rheumatoid) arthritis or degenerative (osteoarthritis). Other considerations include type of work (use or physical demands placed on the elbow), severity of the arthritis, and the age of the patient.

This continuing education review includes a detailed section on each surgical treatment option — how to perform the procedure, when to use it, and what to expect in terms of outcomes or results. It is readily recognized that treatment is different for each person. The authors of this review and continuing education tool were clear in stating that the material was not intended to represent the only methods or best procedures for elbow arthritis. Rather, it provides a helpful review of current approaches used successfully by many orthopedic surgeons.

Other ways to stay current on arthritis available to your physician include other on-line peer reviewed (high quality) publications, on-line webinars, and continuing education at conferences held periodically around the United States. Your physician will likely be able to let you know what kinds of continuing education he or she has pursued over the last one to two years.