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Surgical management of the rheumatoid hand: consensus and controversy among rheumatologists and hand surgeons.

Publication ,  Journal Article
Alderman, AK; Ubel, PA; Kim, HM; Fox, DA; Chung, KC
Published in: The Journal of rheumatology
July 2003

Rheumatoid arthritis (RA) is a common cause of debilitating hand deformities, but management of these deformities is controversial, characterized by large variations in the surgical rates of common RA hand procedures. We conducted a national survey evaluating potential differences in physicians' management of RA hand deformities.We mailed a survey instrument to a random national sample of 500 rheumatologists and 500 hand surgeons in the US. We evaluated physicians' attitudes toward the other specialties' management of common RA hand deformities and toward the indications for performing rheumatoid hand surgery.We found 70% of rheumatologists consider hand surgeons deficient in understanding the medical options available for RA, while 73.6% of surgeons believe rheumatologists have insufficient knowledge of the surgical options for RA hand diseases. However, 66.9% of surgeons and 79.5% of rheumatologists had no exposure to the other specialty during training. The 2 physician groups disagree significantly on the indications for commonly performed RA hand procedures such as metacarpophalangeal joint arthroplasty (p < 0.001), small joint synovectomy (p < 0.001), and distal ulna resection (p = 0.001). When physicians do not agree with others' management of RA hand deformities, only 62.4% of surgeons and 61.9% of rheumatologists relay their concern to the other specialty.Rheumatologists and hand surgeons have minimal interdisciplinary training, communicate with each other infrequently, and significantly disagree on the indications for RA hand surgery. Research must focus on the surgical outcomes of RA hand procedures and on improving communication between rheumatologists and hand surgeons.

Duke Scholars

Published In

The Journal of rheumatology

EISSN

1499-2752

ISSN

0315-162X

Publication Date

July 2003

Volume

30

Issue

7

Start / End Page

1464 / 1472

Related Subject Headings

  • United States
  • Societies, Medical
  • Rheumatology
  • Middle Aged
  • Male
  • Humans
  • Health Care Surveys
  • Hand Deformities, Acquired
  • Female
  • Cross-Sectional Studies
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Alderman, A. K., Ubel, P. A., Kim, H. M., Fox, D. A., & Chung, K. C. (2003). Surgical management of the rheumatoid hand: consensus and controversy among rheumatologists and hand surgeons. The Journal of Rheumatology, 30(7), 1464–1472.
Alderman, Amy K., Peter A. Ubel, H Myra Kim, David A. Fox, and Kevin C. Chung. “Surgical management of the rheumatoid hand: consensus and controversy among rheumatologists and hand surgeons.The Journal of Rheumatology 30, no. 7 (July 2003): 1464–72.
Alderman AK, Ubel PA, Kim HM, Fox DA, Chung KC. Surgical management of the rheumatoid hand: consensus and controversy among rheumatologists and hand surgeons. The Journal of rheumatology. 2003 Jul;30(7):1464–72.
Alderman, Amy K., et al. “Surgical management of the rheumatoid hand: consensus and controversy among rheumatologists and hand surgeons.The Journal of Rheumatology, vol. 30, no. 7, July 2003, pp. 1464–72.
Alderman AK, Ubel PA, Kim HM, Fox DA, Chung KC. Surgical management of the rheumatoid hand: consensus and controversy among rheumatologists and hand surgeons. The Journal of rheumatology. 2003 Jul;30(7):1464–1472.

Published In

The Journal of rheumatology

EISSN

1499-2752

ISSN

0315-162X

Publication Date

July 2003

Volume

30

Issue

7

Start / End Page

1464 / 1472

Related Subject Headings

  • United States
  • Societies, Medical
  • Rheumatology
  • Middle Aged
  • Male
  • Humans
  • Health Care Surveys
  • Hand Deformities, Acquired
  • Female
  • Cross-Sectional Studies