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.
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