Rheumatoid Arthritis of the Elbow: Role of Arthroscopy

Rheumatoid arthritis (RA) is the most common chronic autoimmune disease characterized by symmetric inflammatory polyarthritis, affecting around 0.5% of adults [1]. Among patients diagnosed with rheumatoid arthritis, rates involving elbow joints are about 32% to 61% [2]. Major pathophysiology of RA is a chronic inflammation at the synovium, leading to destruction of the articular cartilage [3]. Larsen classification (Table 26.1) is one of the most commonly utilized radiographic classification of rheumatoid arthritis [4]. Symptoms and clinical manifestation could be differed by the severity of RA and control of the disease (from synovitis with minimal arthritic change to end-stage arthritis). Surgical indication and treatment for the rheumatoid arthritis are basically not different from other arthritis; however, systemic disease control by medication including disease-modifying antirheumatic drugs is important and should be preceded before surgical treatment. Surgical treatment could be considered if systemic treatment and conservative treatment fails. By the severity of arthritis, surgical treatment include synovectomy, osteocapsular arthroplasty, and total elbow replacement arthroplasty [5].