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"We see dramatic differences of opinion and practice over an important clinical problem that will only increase in importance as the population grows older," says co-author Peter Ubel, M.D., associate professor of internal medicine and psychology. "We don't know yet what will work best for individual patients, and so physicians don't agree about the best way to treat this condition. Patients need to be aware of this, and they may need to talk to several doctors to decide what's right for them."

Rheumatoid arthritis affects about 1 percent of the American population, and causes prolonged, painful and often debilitating inflammation and deformity in joints and tendons. Caused by a mysterious autoimmune malfunction, it affects patients for the rest of their lives, often worsening year by year. The condition especially strikes the hands and wrists, where it has a major impact on a patient's ability to perform daily functions such as lifting, eating, personal care and writing.

Medications have long been used to reduce inflammation, and work for many patients for years after diagnosis. But hand surgery has been seen as an option for patients who do not respond to medicines or whose hands have become so twisted and contorted that they no longer work.

The U-M survey studies show that physicians of different specialties are miles apart in their perception of how well surgery can help ease pain, restore function and prevent further problems. And, they're just as divided over how well they think members of the opposite specialty do at managing rheumatoid arthritis patients.

For instance, in the newly published paper, 70 percent of the rheumatologists surveyed considered hand surgeons deficient in their understanding of the non-surgical treatment options
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Contact: Kara Gavin
kegavin@umich.edu
734-764-2220
University of Michigan Health System
25-Jul-2003