THE NATURAL COURSE OF RHEUMATOID ELBOW ARTHRITIS - A RADIOGRAPHIC ANDCLINICAL 5-YEAR FOLLOW-UP

In a prospective study of the natural course of rheumatoid elbow arthr itis, 32 consecutive patients with definite or classical rheumatoid ar thritis from a rheumatological out-patient clinic were followed for 5 years. Clinical, functional and radiographic outcome was evaluated. At follow-up, 47 elbows were available for reexamination. There was no d ifference between initial and follow-up examination regarding clinical and functional parameters. Eighteen elbows with initial radiographic Larsen stages 3-5 had longer disease duration, higher score for pain o n motion, larger extension deficit and less pronation than 29 elbows w ith initial radiographic stages 0-2. There was, however, radiographic progression to a higher stage in one third of the elbows. Measurement of bone attrition on initial and follow-up radiographs of elbows with initial radiographic stages 3-5 also showed progression in one third o f the elbows. The authors conclude that the radiographic progress of e lbow joint destruction in rheumatoid arthritis is slow and that elbow joint destruction does not always give rise to pain. In one third of t he elbows with radiographic stages 3-5 pain is, however, severe, and t otal elbow replacement may be indicated.