On-line First

J Rheum Dis

Published online August 27, 2024

© Korean College of Rheumatology

Surgical treatment of rheumatoid arthritis of the elbow

Wan Kee Hong, M.D.1 , Joong Mo Ahn, M.D., Ph.D.2 , Hyun Sik Gong, M.D., Ph.D.3

1Department of Orthopedic Surgery, CM Hospital, Seoul, 2Department of Radiology, Seoul National University Bundang Hospital, 3Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea

Correspondence to : Hyun Sik Gong, https://orcid.org/0000-0003-4028-1559
Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82 Gumi-ro 173beon-gil, Bundang-gu, Seongnam 13620, Korea. E-mail: hsgong@snu.ac.kr

Received: July 8, 2024; Revised: July 30, 2024; Accepted: August 11, 2024

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Rheumatoid arthritis (RA) is a chronic inflammatory condition that significantly impacts multiple joints, including the elbow, crucial for daily activities. Despite advancements in medical treatments like disease-modifying antirheumatic drugs that delay disease progression, surgical interventions are often necessary to improve the quality of life in RA patients. This review provides a comprehensive evaluation of the elbow, focusing on history taking, physical examination, and radiographic assessments, particularly magnetic resonance imaging findings. We detail the selection and counseling of patients, as well as various surgical options tailored to specific symptoms of RA elbow, including synovectomy for persistent pain due to synovitis, capsulotomy and osteophytectomy for limited range of motion, cubital tunnel release for ulnar neuropathy, and joint replacement or interposition arthroplasty for advanced joint destruction. Additionally, we emphasize the differentiation between RA flare and septic elbow, highlighting the importance of timely and accurate diagnosis. The review underscores the necessity of a multidisciplinary approach, integrating surgical and medical strategies to manage RA elbow effectively.

Keywords Rheumatoid arthritis, Elbow, Surgery, Synovectomy, Arthroplasty

Article

On-line First

J Rheum Dis

Published online August 27, 2024

Copyright © Korean College of Rheumatology.

Surgical treatment of rheumatoid arthritis of the elbow

Wan Kee Hong, M.D.1 , Joong Mo Ahn, M.D., Ph.D.2 , Hyun Sik Gong, M.D., Ph.D.3

1Department of Orthopedic Surgery, CM Hospital, Seoul, 2Department of Radiology, Seoul National University Bundang Hospital, 3Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea

Correspondence to:Hyun Sik Gong, https://orcid.org/0000-0003-4028-1559
Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82 Gumi-ro 173beon-gil, Bundang-gu, Seongnam 13620, Korea. E-mail: hsgong@snu.ac.kr

Received: July 8, 2024; Revised: July 30, 2024; Accepted: August 11, 2024

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Rheumatoid arthritis (RA) is a chronic inflammatory condition that significantly impacts multiple joints, including the elbow, crucial for daily activities. Despite advancements in medical treatments like disease-modifying antirheumatic drugs that delay disease progression, surgical interventions are often necessary to improve the quality of life in RA patients. This review provides a comprehensive evaluation of the elbow, focusing on history taking, physical examination, and radiographic assessments, particularly magnetic resonance imaging findings. We detail the selection and counseling of patients, as well as various surgical options tailored to specific symptoms of RA elbow, including synovectomy for persistent pain due to synovitis, capsulotomy and osteophytectomy for limited range of motion, cubital tunnel release for ulnar neuropathy, and joint replacement or interposition arthroplasty for advanced joint destruction. Additionally, we emphasize the differentiation between RA flare and septic elbow, highlighting the importance of timely and accurate diagnosis. The review underscores the necessity of a multidisciplinary approach, integrating surgical and medical strategies to manage RA elbow effectively.

Keywords: Rheumatoid arthritis, Elbow, Surgery, Synovectomy, Arthroplasty

JRD
Oct 01, 2024 Vol.31 No.4, pp. 191~263
COVER PICTURE
Ancestry-driven pathways for SLE-risk SNP-associated genes. The ancestry-driven key signaling pathways in Asians, Europeans, and African Americans were analyzed by enrichr (https://maayanlab.cloud/Enrichr/#libraries) using non-HLA SNP-associated genes. SLE: systemic lupus erythematosus, SNP: single-nucleotide polymorphism, JAK–STAT: janus kinase–signal transducers and activators of transcription, IFN: interferon gamma. (J Rheum Dis 2024;31:200-211)

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