An Outcome Study of Rheumatoid Hand Arthroplasty

描述(申请人提供)：类风湿性关节炎(RA)是一种进行性和衰弱的疾病，通常会导致手畸形，损害手的功能。一种常见的畸形是掌指关节(MCPJ)，导致尺骨漂移和手指伸展迟缓。由于缺乏RA手外科手术的高水平证据研究，我们在2003年开始了一项前瞻性队列结果研究，以确定硅胶掌指关节成形术(SMPA)重新调整手指的有效性。这项多中心的国际研究涉及风湿学家和手外科医生在三个致力于RA疾病治疗的综合中心的合作。这项目前的赠款是在世界上最大的超过160名RA患者队列中进行的，为期3年。对队列的短期(1年)结果进行了分析，并根据结果问卷评估证实，SMPA手术在纠正尺骨漂移和改善手功能方面非常有效，而接受药物治疗的对照组的手功能保持不变。目前正在分析该项目第三年的数据。我们建议再跟踪这一独特的队列4年，以评估SMPA的长期结果，研究非手术治疗的RA手部疾病的自然历史，并确定长期结果的预测因素。本研究旨在明确这种RA手部疾病的最佳治疗方法，并为指导这种流行疾病的手部手术治疗提供依据。

DESCRIPTION (provided by applicant): 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.