Rheumatoid arthritis (RA) is a progressive and debilitating disease that often causes hand deformities that impair hand function. A common deformity is at the metacarpophalangeal joints (MCPJs) to cause ulnar drift and extension lag of the fingers. Because of the paucity of high-level evidence studies for RA hand surgical procedures, we began in 2003 a prospective cohort outcomes study to determine the effectiveness of silicone metacarpophalangeal joint arthroplasty (SMPA) procedure for realigning the fingers. This multi- center international study involves the collaboration of rheumatologists and hand surgeons at three comprehensive centers dedicated to the treatment of RA diseases. This current grant follows the world's largest cohort of over 160 RA patients prospectively for 3 years. The short-term (1-year) results have been analyzed for the cohort and have confirmed that the SMPA procedure is highly effective in correcting ulnar drift and improving hand function based on outcomes questionnaire assessments, whereas the medically- treated control group's hand function remains unchanged. The data for year 3 of this project are currently being analyzed. We are proposing to follow this unique cohort for an additional 4 years to assess the long-term outcomes of SMPA, to study the natural history of RA hand disease treated nonoperatively, and to determine predictors of long-term outcomes. This study seeks to define the optimal treatment of this RA hand condition and to provide evidence in guiding hand surgery treatment for this prevalent disease.

Agency
National Institute of Health (NIH)
Institute
National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
Type
Research Project (R01)
Project #
5R01AR047328-08
Application #
8525085
Study Section
Neurological, Aging and Musculoskeletal Epidemiology (NAME)
Program Officer
Panagis, James S
Project Start
2011-09-05
Project End
2016-08-31
Budget Start
2013-09-01
Budget End
2014-08-31
Support Year
8
Fiscal Year
2013
Total Cost
$316,220
Indirect Cost
$91,502
Name
University of Michigan Ann Arbor
Department
Surgery
Type
Schools of Medicine
DUNS #
073133571
City
Ann Arbor
State
MI
Country
United States
Zip Code
48109
Mathews, Alexandra L; Coleska, Adriana; Burns, Patricia B et al. (2016) Evolution of Patient Decision-Making Regarding Medical Treatment of Rheumatoid Arthritis. Arthritis Care Res (Hoboken) 68:318-24
Chung, Kevin C; Kotsis, Sandra V; Burns, Patricia B et al. (2016) Seven Year Outcomes of the Silicone Arthroplasty in Rheumatoid Arthritis (SARA) Prospective Cohort Study. Arthritis Care Res (Hoboken) :
Sears, Erika D; Burns, Patricia B; Chung, Kevin C (2015) Relationship between Patient Expectations and Clinical Measures in Patients Undergoing Rheumatoid Hand Surgery from the Silicone Arthroplasty in Rheumatoid Arthritis (SARA) Study. Plast Reconstr Surg 136:775e-81e
Rehim, Shady A; Kowalski, Evan; Chung, Kevin C (2015) Enhancing aesthetic outcomes of soft-tissue coverage of the hand. Plast Reconstr Surg 135:413e-28e
Michelotti, Brett F; Adkinson, Joshua M; Chung, Kevin C (2015) Chronic Scapholunate Ligament Injury: Techniques in Repair and Reconstruction. Hand Clin 31:437-49
Zhong, Lin; Mahmoudi, Elham; Giladi, Aviram M et al. (2015) Utilization of Post-Acute Care Following Distal Radius Fracture Among Medicare Beneficiaries. J Hand Surg Am 40:2401-9.e8
Johnson, Shepard P; Malay, Sunitha; Chung, Kevin C (2015) The quality of control groups in nonrandomized studies published in the Journal of Hand Surgery. J Hand Surg Am 40:133-9
Zhong, Lin; Chung, Kevin C; Baser, Onur et al. (2015) Variation in rheumatoid hand and wrist surgery among medicare beneficiaries: a population-based cohort study. J Rheumatol 42:429-36
Rehim, Shady A; Chung, Kevin C (2015) Educational video recording and editing for the hand surgeon. J Hand Surg Am 40:1048-54
Squitieri, Lee; Chung, Kevin C; Hutton, David W et al. (2015) A 5-Year Cost-Effectiveness Analysis of Silicone Metacarpophalangeal Arthroplasty in Patients with Rheumatoid Arthritis. Plast Reconstr Surg 136:305-14

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