Hong Wan Kee, Ahn Joong Mo, Gong Hyun Sik
Department of Orthopedic Surgery, CM Hospital, Seoul, Korea.
Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea.
J Rheum Dis. 2025 Oct 1;32(4):232-240. doi: 10.4078/jrd.2024.0083. Epub 2025 Aug 27.
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.
类风湿关节炎(RA)是一种慢性炎症性疾病,会对包括肘部在内的多个关节产生显著影响,而肘部对于日常活动至关重要。尽管诸如改善病情抗风湿药物等医学治疗取得了进展,这些药物可延缓疾病进展,但手术干预对于改善类风湿关节炎患者的生活质量往往是必要的。本综述对肘部进行了全面评估,重点关注病史采集、体格检查和影像学评估,尤其是磁共振成像结果。我们详细介绍了患者的选择和咨询,以及针对类风湿关节炎肘部特定症状的各种手术选择,包括因滑膜炎导致持续疼痛的滑膜切除术、因活动范围受限的关节囊切开术和骨赘切除术、因尺神经病变的肘管松解术,以及因晚期关节破坏的关节置换术或间置关节成形术。此外,我们强调了类风湿关节炎发作与化脓性肘部之间的鉴别,突出了及时准确诊断的重要性。该综述强调了采用多学科方法的必要性,将手术和医学策略相结合以有效管理类风湿关节炎肘部。