Rheumatoid arthritis patients caught in middle of doctors' disagreement over hand surgery

ANN ARBOR, MI More than two million Americans with rheumatoid arthritis are caught in the middle of a debate among physicians over which treatment medications or hand surgery will help their ravaged fingers and wrists most.

And a new University of Michigan Health System study finds that entrenched attitudes and lack of communication among rheumatologists and hand surgeons, and a dearth of data comparing the two strategies, are keeping the controversy going.

Only large studies evaluating the effectiveness of various hand operations, the researchers say, will quell the debate and help patients get consistent and beneficial care no matter what kind of doctor they see or where they live.

The multidisciplinary U-M research team reports its latest findings about attitudes among rheumatologists and surgeons in the current issue of the Journal of Rheumatology. They published previous attitude-related results in the Journal of Hand Surgery earlier this year, and last October they reported dramatic state-by-state variation in hand surgery rates in the journal Arthritis & Rheumatism.

"What we're finding is that rheumatoid arthritis care can vary tremendously depending on where patients live, what type of physician they're referred to, how much cross-training and interaction those physicians have with others, and what an individual doctor personally thinks of other specialties," says Amy Alderman, M.D., M.P.H., lead author of all three studies and a resident in Plastic & Reconstructive surgery at UMHS. "Since this is a debilitating, chronic condition that affects so many, it's very concerning that we don't have a consensus or communication among providers."

Alderman and her U-M colleagues -- who include a rheumatologist, a senior hand surgeon, general internists and a statistician -- surveyed nearly 1,000 doctors selected by random sampling from among the members of top rheumatology and hand surgery societies. For the October paper,

Contact: Kara Gavin
University of Michigan Health System

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