Rheumatoid Arthritis Elbows
Treatment of RA elbow pain aims to reduce inflammation and symptoms and improve function.

Rheumatoid arthritis (RA) is an autoimmune disease of the synovia or joint linings. The immune system attacks the body’s tissue, causing inflammation and damage. The joint space narrows because the joint lining swells due to inflammation. The condition slowly deteriorates the bones and soft tissues. Joint pain, swelling, and loss of function may occur. 

People with RA frequently experience elbow pain. This disease affects the same joints on both sides of the body (both elbows). Such involvement of the joints on both sides is called symmetrical arthritis.

How does rheumatoid arthritis affect the elbow?

In the elbow, two bones of the forearm (radius and ulna) meet the bone of the upper arm (humerus). Rheumatoid arthritis (RA) is common in the two joints of the elbow.

  1. Humeroradial joint: Located where the radius and humerus meet. This joint allows you to straighten, bend, and turn your hand so the palm faces up or down.
  2. Proximal radioulnar joint: Located where the radius and ulna meet near the elbow. This joint allows you to rotate your lower arm.

The space in these joints is lined with a thin membrane called the synovium or synovial membrane. The synovium cushions the joints and releases a fluid called synovial fluid, which helps the joints to move.

The immune system of people with RA attacks the healthy tissues and synovium inside the joints. This results in an inflammatory response, which causes pain, swelling, and stiffness. The stiffness is worse in the morning or after periods of inactivity. Some may develop small lumps near their elbows called rheumatoid nodules.

Elbow swelling can increase pressure on nerves, causing numbness and tingling in your fingers, arms, and hands. It can cause elbow dislocation in severe cases.

Joints, cartilage, and ligaments are all damaged as the condition worsens.

What causes rheumatoid arthritis?

Although the exact cause of rheumatoid arthritis (RA) is unknown, scientists believe a combination of hormones, genetics, and environmental factors may play a role in its development. Infection, smoking, and emotional or physical stress can trigger RA.

  • Immune factor
    • The immune system causes abnormal inflammation in the synovium, resulting in joint pain, stiffness, and swelling.
    • In severe cases, the inflammation can significantly damage the joint's cartilage, bone, and other tissues.
  • Genetics
    • Variations in human leukocyte antigen (HLA) genes, particularly the HLA-DRB1 gene, are the most significant genetic risk factors for the development of RA. 
    • The proteins produced by HLA genes help the immune system distinguish between proteins produced by the body and foreign invaders (viruses and bacteria).
  • Environmental factors
    • Although the mechanism is unknown, specific risk factors for the condition include changes in sex hormones (particularly in women), occupational exposure to fibers or dust, viral or bacterial infections, and long-term smoking.

How is rheumatoid arthritis diagnosed?

Because there is no single test to diagnose rheumatoid arthritis (RA) in its initial stages, a doctor will examine the affected joint to identify:

  • Swelling
  • Redness and warmth
  • Decreased range of motion
  • Pain
  • Joint instability

They may recommend the following tests:

SLIDESHOW

What Is Rheumatoid Arthritis (RA)? Symptoms, Treatment, Diagnosis See Slideshow

How is RA of the elbow treated?

Although there is no known cure for rheumatoid arthritis (RA), several treatments for joint pain, stiffness, and inflammation are available. Medications help slow the disease progression and development of complications. The severity of your symptoms determines treatment.

The objectives of RA treatment main to:

  • Stop or reduce inflammation
  • Relieve symptoms
  • Prevent joint and organ damage
  • Improve function and well-being
  • Reduce long-term complications

To treat RA, doctors use a combination of medications, lifestyle changes, and surgery.

Nonsurgical treatments for RA elbow pain

Treatment usually begins with nonsurgical options and can help reduce your symptoms and prevent them from worsening. The options may include:

  • Limit or stop the activities that worsen elbow pain.
  • Wear an elbow splint to support your joints and relieve stress.
  • Take nonsteroidal anti-inflammatory drugs, such as ibuprofen or naproxen, to reduce pain and inflammation.
  • Exercise to improve the function and range of motion in your elbow. Your doctor may recommend that you work with a physiotherapist to determine which activities are best for you.
  • Steroid injections for your elbow joint to reduce inflammation.
  • Apply heat or cold to your elbows to help reduce swelling and pain.

If none of these treatment options provide relief, disease-modifying antirheumatic drugs (DMARDs) could be prescribed by your doctor.

  • DMARDs prevent the immune system from attacking the joints and reduce joint damage and joint deformity.
  • They have benefits and risks, so discuss with your doctor whether these medications are right for you.

Surgical treatments for RA elbow pain

Elbow surgery seeks to improve or restore your arm and elbow function to relieve pain. The severity of your joint damage determines the type of surgery used.

Surgical procedures include:

  • Synovectomy: The surgeon removes the synovium (a thin membrane that lines the joints).
  • Arthroscopic debridement: A small camera is inserted (arthroscope) into the elbow joint. The camera displays images onto a screen, which is used to guide small surgical instruments. The surgeon then cleans the inside of the joint. In some cases, the radius's head is removed.
  • Arthroplasty:
    • Elbow interposition joint replacement: The ends of the bones in the elbow joint are reshaped to prevent them from rubbing together. A small section of the Achilles tendon or other soft tissue is fitted between the joint surfaces.
    • Total elbow joint replacement: The surgeon removes the damaged cartilage and bones in the elbow and replaces a new metal or plastic joint surface to restore joint function.

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Medically Reviewed on 11/23/2022
References
Image Source: iStock image

Rheumatoid Arthritis Signs and Symptoms. https://www.hopkinsarthritis.org/arthritis-info/rheumatoid-arthritis/ra-symptoms/

Rheumatoid arthritis. https://www.mayoclinic.org/diseases-conditions/rheumatoid-arthritis/symptoms-causes/syc-20353648

Clinical manifestations of rheumatoid arthritis. https://www.uptodate.com/contents/clinical-manifestations-of-rheumatoid-arthritis

When Elbow Pain May Mean Arthritis. https://www.arthritis.org/health-wellness/about-arthritis/where-it-hurts/when-elbow-pain-may-mean-arthritis

Elbow Arthritis. https://orthop.washington.edu/patient-care/hand/elbow-arthritis.html