Elbow Pain, Swelling, and Inflammation

The elbow is a remarkable joint that allows us to position our forearm and hand in space and carry out many different functions, from throwing a ball to removing a cup from a cupboard. When rheumatoid arthritis (RA) affects the elbow, it can make a range of common tasks and movements difficult or impossible.

The elbows are often among the first joints affected by RA. This can cause pain and discomfort, as well as significant disability. Studies have found that RA affects 1 or both elbow joints in 20 to 65 percent of people with the condition.1,2

How does rheumatoid arthritis affect the elbow?

The elbow is formed where the 2 bones of the forearm (radius and ulna) meet the bone of the upper arm (humerus). RA is common in the 2 joints of the elbow:3

  • Humeroradial joint – This is located where the radius and humerus meet. This joint allows you to bend and straighten your arm, as well as turn your hand over so the palm faces up or down.
  • Proximal radioulnar joint – This is located radius and ulna meet. This joint allows you to rotate your lower arm.

The space in these joints is lined with a thin membrane called the synovium. The synovium cushions the joints and releases a fluid that makes it easier for your joints to move. This is called synovial fluid.3

In people with RA, the body’s immune system attacks the synovium and healthy tissues inside the joints. This causes an inflammatory response that results in swelling, stiffness, and pain, especially when the joint is used. Some people also develop small lumps, known as rheumatoid nodules, near their elbow.2,4

Swelling in the elbow joints can put pressure on nerves, which causes tingling and numbness in your arms, hands, and fingers. In severe cases, it can cause the elbows to dislocate.4,5

RA is sometimes symmetrical, which means it usually affects the same joints on both sides of the body. As the condition gets worse, ligaments, joints, and cartilage become more damaged.4,6

RA symptoms often experience periods when their symptoms become worse, known as flare-ups or flares. These flares are then followed by periods when symptoms decrease.

The exact cause of RA is not known. Researchers believe that some people have genes that make them more likely to develop RA. However, this does not mean that people with these genes automatically develop RA. There is usually something that triggers the condition, like an infection. This causes the immune system to start attacking the joints.4,6

There is no cure for RA, but there are a range of treatment options for the inflammation, pain, and stiffness that affect the joints. Treatment depends on your symptoms and how severe they are. The goals of treatment are to:7

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

Doctors usually use a combination of medicines, lifestyle changes, and surgery to treat RA.

Nonsurgical treatments for RA elbow pain

In most cases, treatment begins with nonsurgical options. They can help reduce your symptoms and help them from getting worse. The options may include:5

  • Limiting or stopping activities that make your elbow pain worse
  • Wearing an elbow splint to help support your joints and ease the stress placed on it
  • Taking nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen to help reduce pain and inflammation
  • Doing exercises that help improve the range of motion and function in your elbow. Your doctor may have you work with a physical therapist to find exercises that work best for you.
  • Getting steroid injections into your elbow joints can help reduce inflammation
  • Applying cold or heat to your elbows to help reduce pain and swelling

If the above options do not improve your RA symptoms, your doctor may prescribe disease-modifying anti-rheumatic drugs (DMARDs). These are drugs that are designed to stop the immune system from attacking the joints. This slows or prevents joint deformity. There are both benefits and risks of DMARDs, so talk to your doctor about whether these drugs are right for you.8

Surgical treatments for RA elbow pain

If your RA symptoms do not respond to nonsurgical options or medicines and your quality of life has been impacted by your arthritis, your doctor might recommend surgery. The goal of elbow surgery is to improve or restore your elbow and arm function, and provide pain relief.1

The type of surgery used depends on how severely your joints are damaged. Surgeries include:1,9

  • Synovectomy – During this procedure, the surgeon removes the synovium, the thin membrane that lines the joints.
  • Arthroscopic Debridement – During this procedure, the surgeon inserts a small camera (arthroscope) into your elbow joint. The camera displays images on a screen, and the surgeon uses the images to guide small surgical instruments. The surgeon then cleans out the inside of the joint. In some cases, the head of the radius is also removed.
  • Elbow interpositional joint replacement (arthroplasty) – During this procedure, the surgeon reshapes the ends of the bones in the elbow joint to stop them from rubbing together. A small section of your Achilles tendon or other soft tissue is then fitted between the joint surfaces.
  • Total elbow joint replacement (arthroplasty) – During this procedure, the surgeon removes the damaged cartilage and bones in your elbow. They will then place new metal or plastic joint surfaces to restore your joint function.

Learn more about elbow surgery

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Written by: Jonathan Simmons & Heather Morse | Last reviewed: October 2020