My daughter has had rheumatoid arthritis all her life. She's still very young (33 years old) but has disabling elbow pain and can't even use her right arm. Medications have helped but not enough. Should I suggest she see a surgeon? Can't they do elbow replacements now?
Treatment for rheumatoid arthritis is divided into two types: conservative (nonoperative) and surgery. Nonsurgical treatment usually begins with medications to control symptoms and prevent damage to the joint. For some patients, the use of antiinflammatory drugs and disease modifying anti-rheumatic drugs (DMARDs) can completely eliminate all signs and symptoms of rheumatoid arthritis.
It sounds like your daughter has been treated with medications. But if she is still having problems, she should go back to her rheumatologist for a follow-up visit. It is often possible to make changes in medications that can help.
No matter what the cause of the problem is, activity modification, rest, and physical therapy are often recommended. Sometimes splinting is advised to help protect, support, and mobilize (move) the joint. If after three to six months of conservative care, there is no improvement (or the symptoms are worse), then surgery may be an option.
There are various types of surgical procedures to consider. Which one is selected depends on the patient's age, diagnosis, job demands, or sports participation. The selection of surgical procedures also takes into account the areas of the joint affected most (e.g., joint surface, capsule, synovium). The surgeon does everything possible to preserve the dynamic nature of the joint -- both stability and mobility needed for upper extremity function.
Elbow fusion is a possibility but the patient faces loss of motion and some function. At 33, she's still too young for a joint replacement. One procedure that is being used with good results in younger patients is the interposition arthroplasty.
This surgical technique shaves away the joint surface, removing any bone spurs and loose fragments of bone or cartilage in the joint. A piece of tendon used as a graft is placed where the surfaces of the elbow joint are rubbing together. The main goal of interposition surgery is to ease pain by using the soft tissue graft to form a spacer separating the surfaces of the joint. The patient can still lift more than the 10-pound lifting limit imposed on total elbow replacements.
Zinon T. Kokkalis, MD, et al. Elbow Arthritis: Current Concepts. In The Journal of Hand Surgery. April 2009. Vol. 34A. No. 4. Pp. 761-768.
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