Case-Based Examples of Management of Rheumatoid Elbow

Abstract

The algorithm of treatment of the rheumatoid elbow is derived from the understanding of the developmental aspects of the disease. The therapeutic choices vary in line with the stage of the disease and its evolution trend. A classification of the different modalities of the rheumatoid elbow involvement should be able to support the therapeutic indication. The bone stock quality and the tendency to bone resorption, cyst formation, and progressive instability versus ankylosis should be clearly appraised. In this regard, the Larson’s staging, even if handy to be used, should only be considered as a radiographic definition of the current state of the affected joint and may not have sufficient clinical relevance. Our algorithm of treatment is based on classifying five different RA elbow conditions: (1) Synovitis, antalgic ROM reduction; normal appearing joint. (2) Synovitis, minor ROM reduction; loss of joint space, maintenance/minimal alteration of the subchondral architecture (either uniform or showing a prevailing involvement of the radial compartment). (3) Joint stable, ROM reduction, marked joint space narrowing, cyst formation. (4) Instability; gross deformity (“wet type”). (5) Joint ankylosis. Treatment options can be referred accordingly to each stage or pattern.