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Two University of Michigan
studies look at surgeons vs. rheumatologists
debate on best approach for treating patients
with RA; surgery works if done early
ANN ARBOR, Mich. - Two
University of Michigan studies supported by
the National Institutes of Health may bridge the
gap between rheumatologists and hand surgeons as
they work toward the common goal of improving
the quality of life for patients with rheumatoid
arthritis.
A study appearing in the
current issue of Plastic and Reconstructive
Surgery reveals that one of the most common
conditions caused by rheumatoid arthritis is
best treated surgically, sooner rather than
later.
Patients with RA frequently
experience a debilitating condition known as
metacarpophalangeal joint disease, which can be
treated by replacing the knuckle joints with
solid silicone joints.
However, this treatment has
spurred great disagreement between hand surgeons
and rheumatologists regarding the indications,
timing and perceived outcomes of the procedure:
rheumatologists tend to refer late-stage
patients for surgery whereas hand surgeons
believe that earlier intervention can yield more
positive outcomes.
In the largest cohort study
of its kind, U-M researchers and their
colleagues evaluated the surgical outcomes for
patients from Michigan, Maryland and the United
Kingdom who suffered from varying degrees of
hand deformities.
”It is the first rigorous
assessment of the outcomes of a
commonly-performed major procedure for
reconstruction of hands that have been damaged
by rheumatoid arthritis,” says
David A. Fox, M.D., professor of internal
medicine at U-M Medical School and chief of the
Division of Rheumatology. “This study
informs rheumatologists, surgeons and patients
with RA as to what they can expect from
reconstructive hand surgery on the
metacarpalphalangeal joints.”
Following reconstruction
patients were separated into two groups based on
the degree of deformity, and the outcomes of the
reconstruction were assessed at six months, and
at years one, two and three. After
reconstruction, both groups had positive
self-reported hand outcomes and showed
statistically significant improvement from the
start of the study.
However, researchers found
that the more severe group still had significant
deformities – showing that the more serious the
malformation, the more difficult it is to
correct.
“This is a unique
collaborative project between hand surgeons and
rheumatologists to generate high-quality data to
help rheumatoid patients,” says lead author
Kevin C. Chung, M.D., M.S.,
professor in the Department of Surgery at
the U-M Medical School. “We will continue to
follow this unique group of patients over the
course of seven years to get more pertinent
outcomes data to guide the treatment of the
rheumatoid hand.”
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