Rheumatoid Arthritis (RA) in Elbows

Medically Reviewed by Sabrina Felson, MD on March 29, 2022
5 min read

When you have rheumatoid arthritis (RA), you’re likely to feel it in multiple joints. It’s common in hands, wrists, and knees. But there’s a good chance you’ll also feel it in your elbows.

RA happens when your immune system attacks the linings of your joints. This can cause pain, swelling, stiffness, and damage to joints anywhere in your body, including your elbows. It’s possible to have other types of arthritis in your elbows. But RA is the most common type of elbow arthritis.

Estimates show that at least 1 in 5 people with RA will have symptoms in one or both elbow joints. If you have RA in one elbow, there’s a good chance you’ll also have it in the other elbow. It’s possible but pretty rare to have RA only in the elbows and not in other joints.

The elbow is a unique joint. Three arm bones in it connect and move in different ways. Thanks to your elbow, you can move your lower arm all around and place your hand in lots of different ways.

When you have RA in your elbows, it might hurt to bend them. But it also can hurt to straighten your arms out. The pain of RA can make it hard to do many normal tasks and activities. The stiffness that comes with elbow arthritis also may be disabling if you don’t treat it.

At first, you’ll likely notice pain and stiffness. When you have RA in your elbows, you may have a hard time bending and straightening your arm back out. It might also hurt to rotate your lower arms.

You might have other symptoms, too:

  • A swollen elbow joint
  • An unstable elbow or one that gives out
  • Trouble moving your elbow and arms fully
  • An elbow that catches or locks up
  • Pain in other joints, such as your wrists or shoulders

Some people with RA in their elbows also will have rheumatoid nodules. These are firm lumps under the skin that happen in about 1 in 5 people with RA. Rheumatoid nodules might hurt sometimes, but they aren’t usually tender. Rarely, the skin on top of nodules may get an ulcer or infection.

Your doctor will ask you about your elbow symptoms. They’ll look carefully at your elbow joint to see how well you can move it. They’ll also check to see if any other joints show signs of arthritis, such as those in your shoulders, wrists, hands, or spine.

Your doctor may order blood tests to look for signs of inflammation. They’ll use X-rays or other imaging tests to look at your elbow joints. They’ll look for swelling and changes in the amount of space in your joints. RA can cause your joints to narrow.

They’ll look to see if there is damage to your joints or bone loss. If your elbow arthritis is severe, you could have lost some of the cartilage that normally should be there.

You can treat RA pain in your elbows with over-the-counter pain relievers. But early treatment with other medicines can help you to avoid joint damage and stay active. It’s a good idea to see a doctor to find out if you have RA and treat it early.

Your doctor may inject cortisone or other steroids into your elbow joint. This can help with pain for a few months. It’s most likely you’ll have this treatment early while you're waiting for other medicines to start working. You might also use steroids this way if your RA flares up later.

Your doctor will also use what’s known as disease-modifying antirheumatic drugs (DMARDs). A common older one is methotrexate. This drug and others like it can help with elbow pain and swelling. It also can help prevent damage to your elbow joint.

If older drugs like methotrexate aren’t enough, your doctor may add a newer biologic DMARD. Biologics are antibodies that block your immune system in different ways. Your doctor can help you decide which biologic to try first. You may switch to different ones, depending on how the treatment works for your elbow RA.

If treatment isn’t enough to control symptoms and keep your elbow joints moving, your doctor might recommend you have surgery. Your options for surgery may include:

  • Elbow synovectomy.

Your surgeon will make small cuts in your elbow and put a thin and flexible instrument called an arthroscope in. This lets your surgeon see the joint, bones, and other tissues in your elbow. They’ll remove diseased tissue called the synovium, which is where the surgery gets its name. Synovium is the normally paper-thin tissue that lines the inside of joints. If you have RA, it can become thickened and inflamed. This type of surgery often is used in early RA. The goal is to remove the diseased tissue. It often helps with pain and allows the joint to move more freely.

  • Elbow arthroplasty.

Your surgeon will use an arthroscope to see the joint, bones, and other tissues in your elbow. They’ll rebuild your damaged joint and remove any loose or diseased tissue.

  • Elbow joint replacement.

This type of surgery can still be called arthroplasty. The difference is that your surgeon will completely replace your elbow joint with artificial parts. While this can help, it isn’t usually done except in older people or those whose RA and damage to the elbow joint are very advanced.

After surgery, your arm will be splinted or in a cast for several weeks. Follow your doctor’s advice. They may tell you to keep your elbow elevated and ice it. You’ll take medicine for pain. Depending on what type of surgery you had, you may see a physical therapist to help you start using your elbow again and keep it from getting stiff.

There are other things you can do to help with your elbow RA. Some tips include:

  • Your doctor might suggest that you take it easy or change your activities. Some types of exercise or activity will be harder on your joints than others. It’s still a good idea to exercise when you have arthritis. Studies show that staying physically active can help with pain and your ability to function with arthritis.
  • It may help to warm your elbow joints up in the morning with a heating pad or shower. Try icing them at night to reduce swelling. This may especially help after you’ve been active.
  • Splints or braces can help support your elbows and help them swell less. Ask your doctor if you should wear splints while you sleep at night.
  • If you are overweight, it can help to lose some extra pounds. When you are carrying extra weight, it puts more stress on your joints. There’s also evidence that sticking to a healthy weight helps keep arthritis from getting worse.
  • Your doctor might also suggest trying an anti-inflammatory diet, like the Mediterranean diet. Such diets include eating plenty of fruits and vegetables, fish, and olive oil.