The two groups of doctors differed significantly in their opinions of when particular operations might be appropriate for particular patients. Presented with case studies of hypothetical patients, they disagreed across the board on when joint replacement (arthroplasty), joint lining removal (synovectomy) and wrist bone surgery (resection of distal ulna) were indicated.
In the Journal of Hand Surgery paper published earlier this year, the U-M team found that the two types of doctors differed greatly on their perceptions of what surgery could actually do for patients. More than 82 percent of the hand surgeons, for example, felt that joint replacement improves hand function, as opposed to 34 percent of rheumatologists.
Meanwhile, 93 percent of the surgeons thought that removing the sheath around a tendon (tenosynovectomy) could prevent future ruptures of the tendon, compared with 54 percent of rheumatologists. And 52 percent of surgeons felt that small-joint synovectomy could delay the destruction of a knuckle joint, compared with 12 percent of rheumatologists. Thirty-five percent of rheumatologists felt that operation was never a good idea for patients.
These different world views on surgery are reflected in the state-by-state variation in surgery for rheumatoid arthritis that the researchers reported last fall. They found that some operations were performed as much as 12 times more often in some states than in others.
The different "management concepts" that rheumatologists and hand surgeons have for rheumatoid arthritis patients are only further divided by the fact that specialists in the two fields tend to read and publish research findings in their own field's journals, says Alderman.
And, she notes, only small uncontrolled studies have been performed to
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Contact: Kara Gavin
kegavin@umich.edu
734-764-2220
University of Michigan Health System
25-Jul-2003