Rheumatoid arthritis (RA) affects 2.1 million Americans and costs the United States an estimated $8.7 billion annually in medical costs and wages. RA is a progressive disease, and approximately 25% of RA patients experience hand deformities associated with the destruction of the metacarpophalangeal (MCP) joints. For the past 30 years, Swanson Metacarpophalangeal Joint Arthroplasty (SMPA) has been performed to correct MCP joint deformity in the rheumatoid hand. The goals of SMPA are pain relief, restoration of function, and aesthetic improvement. Despite its wide application, SMPA remains a controversial procedure. Hand surgeons and rheumatologists frequently disagree about the indications for this procedure and its value to their patients. In addition, most published studies to-date have been hampered by inadequate consideration of research design, small sample size, and inconsistent outcome measures. To provide a better understanding of the effectiveness of SMPA, a multi-center international outcomes study will be carried out to evaluate a cohort of RA patients with severe MCP joint subluxation who will either be enrolled into a SMPA (surgery plus medical therapy) group or a non-SMPA (medical therapy alone) group. Our research question asks whether RA patients who undergo SMPA will have different outcomes than those who are treated only medically. Patients will be evaluated at six months, one year, two years, and three years after surgery (SMPA group) or study entry (non-SMPA group). Outcome evaluations will be based on the Michigan Hand Outcomes Questionnaire, the Arthritis Impact Measurement Scales questionnaire, and standard objective hand function tests. The purpose of this project is to measure short- and long-term outcomes following SMPA and to define its indications for members of specific patient groups and disease severity strata. Most importantly, this project will combine the experiences of both surgery and rheumatology services to jointly evaluate this surgical procedure.

National Institute of Health (NIH)
National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
Research Project (R01)
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Study Section
Orthopedics and Musculoskeletal Study Section (ORTH)
Program Officer
Panagis, James S
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University of Michigan Ann Arbor
Schools of Medicine
Ann Arbor
United States
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Chung, Kevin C; Kotsis, Sandra V; Burns, Patricia B et al. (2017) Seven-Year Outcomes of the Silicone Arthroplasty in Rheumatoid Arthritis Prospective Cohort Study. Arthritis Care Res (Hoboken) 69:973-981
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
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
Chung, Kevin C; Nellans, Kate W; Burns, Patricia B et al. (2015) Patient expectations and long-term outcomes in rheumatoid arthritis patients: results from the SARA (Silicone Arthroplasty in Rheumatoid Arthritis) study. Clin Rheumatol 34:641-51
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
Rehim, Shady A; Chung, Kevin C (2015) Educational video recording and editing for the hand surgeon. J Hand Surg Am 40:1048-54
Michelotti, Brett F; Adkinson, Joshua M; Chung, Kevin C (2015) Chronic Scapholunate Ligament Injury: Techniques in Repair and Reconstruction. Hand Clin 31:437-49
Maroukis, Brianna L; Ogawa, Takeshi; Rehim, Shady A et al. (2015) Guyon canal: the evolution of clinical anatomy. J Hand Surg Am 40:560-5
Giladi, Aviram M; Yuan, Frank; Chung, Kevin C (2015) Plastic surgery practice models and research aims under the Patient Protection and Affordable Care Act. Plast Reconstr Surg 135:631-9
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

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