Inflammatory arthritis and the elbow surgeon

Area of Science:

• Orthopaedic Surgery
• Rheumatology
• Inflammatory Arthritis Management

Background:

• Disease-modifying drugs and biologics have reduced surgical needs in inflammatory arthritis.
• Surgical treatment for inflammatory arthritis is challenging due to bone/soft tissue issues and comorbidities.
• A multidisciplinary approach is crucial for managing complex cases with poly-articular involvement and systemic impairment.

Purpose of the Study:

• To review elbow pathologies in inflammatory arthritis.
• To discuss surgical treatment strategies for orthopaedic surgeons.
• To outline management for both rheumatoid and seronegative arthritis affecting the elbow.

Main Methods:

• Review of articular and peri-articular pathologies affecting the elbow in inflammatory arthritis.
• Classification of rheumatoid elbow into four surgical types: soft tissue, osteoarthritic, nodular, and mutilans.
• Discussion of disease-specific management for peri-articular soft tissue issues in seronegative arthritis.

Main Results:

• Rheumatoid elbow classification aids surgical planning: soft tissue, osteoarthritic, nodular, and mutilans types.
• Surgical management strategies are detailed for each rheumatoid elbow subtype.
• Seronegative arthritis primarily affects peri-articular tissues, requiring specific management for enthesopathies and nodules.

Conclusions:

• Effective management of inflammatory elbow arthritis requires understanding specific pathologies and tailored surgical strategies.
• A multidisciplinary approach is essential for optimizing outcomes in complex cases.
• This review provides a comprehensive guide for surgeons managing elbow involvement in inflammatory arthritis.