Abstract
Objective:
Rheumatoid arthritis often results in deformities at themetacarpophalangeal (MCP) joint. Patients with severe deformities can be treated by silicone metacarpophalangeal joint arthroplasty (SMPA).The objective of the study is to prospectively compare long-term outcomes for a SMPA surgical anda non-surgical cohort of rheumatoid arthritis patients.
Methods:
A total of 67 surgical and 95 nonsurgical patients with severe subluxation and/or ulnar drift of the fingers at the MCP jointswere recruited from 2004-2008in this multi-center prospective cohort study. Patients could electto undergo SMPA or not.Outcomes included the Michigan Hand Outcomes Questionnaire (MHQ), Arthritis Impact Measurement Scales (AIMS2), grip/pinch strength, Jebson-Taylor test and ulnar deviation, extensor lag and arc of motion measurements at the MCP joints.
Results:
There was no significant difference in the mean age, race, education, and income at baseline between the two groups. Surgical subjects had worse MHQ function and functional measurements at baseline. At 3 years, the mean overall MHQ score and the MHQ function, activities of daily living, aesthetics and satisfaction scores showed significant improvement in the surgical group compared to the non-surgical group. Ulnar deviation, extensor lag and arc of motion in the MCP and PIP joints also improved significantly in the surgical group. No improvement was seen in the mean AIMS2 scores and grip/pinch strength.Complications were minimal with a fracture rate of 9.5%.
Conclusion:
RA patients with poor baseline functioning showed long term improvement in hand function and appearance following treatment with SMPA compared to non-surgical controls.
Study registered at Clinical trials.gov, NCT00124254, http://www.clinicaltrials.gov © 2012 by the American College of Rheumatology
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