Extended report
Valgus deformity and proximal subluxation of the rheumatoid
elbow: a radiographic 15 year follow up study of 148 elbows
J T Lehtinena, K Kaarelaa, M J Kauppia, E A Belta, H Mäenpääa, P Kuuselaa, M U K Lehtob
a Rheumatism
Foundation Hospital, Heinola, Finland, b Tampere University Hospital,
Tampere, Finland
Correspondence to: Dr M U K Lehto, Tampere University Hospital, Department of Surgery, PO Box 2000, 33521 Tampere, Finland matti.lehto{at}tays.fi
Accepted for publication 17 November
2000
OBJECTIVE
To evaluate
the nature of positional changes of humeroulnar (HU) and humeroradial
(HR) joints in a cohort of 74 patients with seropositive and erosive
rheumatoid arthritis (RA) followed up prospectively.
METHODSAt the 15 year
follow up standard anteroposterior and lateral radiographs of 148 elbow
joints were evaluated. The mediolateral HU angle of the elbow was
measured from anteroposterior radiographs. The proximal subluxation of
the HU joint was measured from lateral radiographs as the distance
between the posterior aspect of the olecranon process and the posterior
surface of the humerus. The anteroposterior subluxation of the HR joint
was measured from lateral radiographs as the relation of the midpoint
of head of the radius to the midpoint of the capitellum of the humerus.
Destruction of the elbow joints was assessed with the Larsen method on
a scale of 0 to 5 and compared with the measurements.
RESULTSMean HU angle
in 148 elbows of patients with RA was 11.5° (SD 6.1), range 
21°
(varus) to 34° (valgus); 9.9° (SD 4.3) in men and 12.0° (SD 6.4)
in women. The mean HU angle, 14.4° (SD 6.0) of the affected joints
(Larsen grades 2-4), showed more valgus than the mean 9.8° (SD 2.5)
of the non-affected (Larsen grades 0 to 1) joints; totally destroyed
and unstable Larsen 5 joints were excluded. Mean HU and HR
subluxations, 2.0 mm (SD 3.8) and 0.8 mm, of the affected joints
(Larsen 2-5) were greater than the means, 1.1 mm (SD 1.5) and
0.4 mm (SD 0.9), of the non-affected joints. Both the HU proximal
subluxation and the HR anterior subluxation correlated,
rs=0.64 (95% CI 0.53 to 0.73 )
and rs=0.48 (95% CI 0.34 to
0.60), with the destruction of the elbow joint.
CONCLUSIONSThe elbow
seems to turn into valgus during rheumatoid destruction and excision of
the radial head may speed up this process. However, totally unstable
Larsen grade 5 joints may also have varus deformity owing to mutilating
bone destruction. The ulna subluxates proximally in relation to the
humerus, whereas the radius moves slightly anteriorly as a consequence
of elbow involvement.
© 2001 by Annals of the Rheumatic Diseases
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