Study: Rheumatologists, Surgeons Disagree on Hand Surgery for Arthritis

Rheumatologists and hand surgeons cannot agree on whether medication or hand surgery is best for rheumatoid arthritis patients with severe hand and wrist problems.

That's why patients need to seek out the advice of other doctors to find out which course is best for them, according to a study reported in the July issue of the Journal of Rheumatology.

Although medications have long been used to reduce inflammation, hand surgery is an option for patients who do not respond to medicines or whose hands have become so twisted and contorted that they no longer function.

University of Michigan Health System researchers found that 70 percent of rheumatologists and 74 percent of hand surgeons believe that the other specialty doesn't understand the medical options available for rheumatoid arthritis.

The survey also revealed that 70 percent of surgeons and 80 percent of rheumatologists have no exposure to the other specialty during training, and that their perception of how well surgery can help ease pain, restore function and prevent further problems varies widely.

Besides a lack of data on the subject, the researchers blame entrenched attitudes and miscommunication for the stand-off and note that only large studies testing the effectiveness of various hand operations will end the debate and help patients get consistent and beneficial care.

Study author Dr. Amy Alderman, a resident in plastic and reconstructive surgery at the university, said rheumatoid arthritis care varies, depending on where patients live, 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.

"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," said study co-author Dr. Peter Ubel, associate professor of internal medicine and psychology at the university. "Patients need to be aware of this, and they may need to talk to several doctors to decide what's right for them."

As new medications come into widespread use to help control the damage caused by the inflammation of rheumatoid arthritis and prevent progression of the disease, Alderman said fewer patients may need early, aggressive surgery that preventively removes joint linings.

But more patients may eventually need joint replacement or synovial surgery after medications start losing their effectiveness. The speed with which they get that surgery may have a lasting impact on how well their hands regain function, she added.

Other sources: Journal of Rheumatology 2003;30:1464-72