Study: Are Drugs or Surgery Best for Rheumatoid Arthritis-Ravaged Hands

An upcoming study will seek to resolve the controversy over how to ease pain and restore joint function in the hands of those who have rheumatoid arthritis.

Rheumatoid arthritis cripples and deforms the hands of nearly one in four Americans who have the disease. Rheumatologists tend to favor medications, while hand surgeons believe that many patients are best helped by an operation to replace their knuckles with artificial joints.

The researchers will use a $1.25 million grant from National Institutes of Health to conduct what they claim will be the first definitive, scientific study to prove what works best in different patients.

Study sites will be the University of Michigan, Pulvertaft Hand Center in England and the Curtis National Hand Center in Baltimore. Researchers include both hand surgeons and rheumatologists.

"We need an evidence-based approach to show what strategy gives the best result for various kinds of patients, and we hope this study will provide that proof," said researcher Dr. Kevin C. Chung, a hand surgeon at the University of Michigan. "We know there's a major discrepancy of viewpoints between doctors of both specialties, and only solid data will correct that."

"Many patients with rheumatoid arthritis need a combination of medical and surgical treatment, but while the drugs have all been through extensive clinical trials, it's much more difficult to do trials of surgical procedures," said researcher Dr. David Fox, a rheumatologist at the University of Michigan. "By putting this surgical procedure to a carefully controlled test, we may learn just how effective it is and which patients are most suitable to undergo it."

The new study will evaluate a joint-replacement operation that has become standard in the last 30 years, called Swanson Metacarpophalangeal Joint Arthroplasty.

In all, 200 rheumatoid arthritis patients with hand deformities will either be treated with medications or medications plus surgery on one of their arthritic hands. The participants will be evaluated periodically for three years to measure their hands' physical range, their ability to perform daily activities and their overall quality of life.

Other sources: University of Michigan