Miles Apart
Physicians differ dramatically in rheumatoid arthritis treatment protocols
More than two million Americans with rheumatoid arthritis are caught in the
middle of a debate between rheumatologists and surgeons over what the most
effective treatment for their chronic, debilitating condition is. Anti-inflammatory
medications work for many patients, but hand surgery has been proposed as an
option for those who do not respond to medicines or whose hands are twisted
and contorted.
Amy Alderman
Photo: D.C. Goings |
Amy Alderman, M.D., a resident in plastic and reconstructive surgery, led
a U-M research team that surveyed nearly 1,000 physicians in different specialties
about how best to treat patients with rheumatoid arthritis. The survey found
that physicians were miles apart in their treatment protocols and in their
perception of how well surgery can help ease pain, restore function and prevent
further problems.
"Treatment varies depending on where patients live, what type of physician
they're referred to, how much cross-training and interaction those physicians
have with others, and what an individual doctor personally thinks of other
specialties," says Alderman. Only large studies evaluating the effectiveness
of various hand operations, she says, will quell the debate and help patients
get consistent and beneficial care no matter what kind of doctor they see or
where they live.
Alderman's collaborators include Kevin C. Chung, M.D., associate professor
of plastic and reconstructive surgery; Peter A. Ubel, M.D., associate professor
of internal medicine; David A. Fox, M.D., professor and chief of rheumatology;
and H. Myra Kim, Sc.D., an associate research scientist in the U-M School of
Public Health. The study was supported in part by a grant from the Robert Wood
Johnson Foundation and the American Society for Surgery of the Hand. Alderman
is a former Robert Wood Johnson Clinical Scholar at the University of Michigan.
-KG
For an expanded version of this article:
www.med.umich.edu/opm/newspage/2003/handsurgery.htm
For more about rheumatoid arthritis:
www.med.umich.edu/1libr/aha/aha_rheuarth_sha.htm
 
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