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.

Agency
National Institute of Health (NIH)
Institute
National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
Type
Research Project (R01)
Project #
5R01AR047328-04
Application #
7103415
Study Section
Orthopedics and Musculoskeletal Study Section (ORTH)
Program Officer
Panagis, James S
Project Start
2003-09-08
Project End
2008-08-31
Budget Start
2006-09-01
Budget End
2007-08-31
Support Year
4
Fiscal Year
2006
Total Cost
$272,221
Indirect Cost
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
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
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
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
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
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
Waljee, Jennifer; Zhong, Lin; Baser, Onur et al. (2015) The incidence of upper and lower extremity surgery for rheumatoid arthritis among Medicare beneficiaries. J Bone Joint Surg Am 97:403-10

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