Original Article

Clinical Rheumatology

, Volume 29, Issue 4, pp 363-367

First online:

Differences between the United States and the United Kingdom in the treatment of rheumatoid arthritis: analyses from a hand arthroplasty trial

  • Kevin C. ChungAffiliated withSection of Plastic Surgery, Department of Surgery, University of Michigan Health System Email author 
  • , Sandra V. KotsisAffiliated withSection of Plastic Surgery, Department of Surgery, University of Michigan Health System
  • , David A. FoxAffiliated withDepartment of Internal Medicine, Division of Rheumatology, University of Michigan Health System
  • , Marian ReganAffiliated withDerbyshire Royal Infirmary
  • , Frank D. BurkeAffiliated withPulvertaft Hand Centre
  • , E. F. Shaw WilgisAffiliated withCurtis National Hand Center
  • , H. Myra KimAffiliated withCenter for Statistical Consultation and Research, University of Michigan

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Previous studies have found differences in rheumatoid hand surgical practice around the world. The specific aim of this study is to compare baseline characteristics of rheumatoid arthritis (RA) patients in the United States (US) and the United Kingdom (UK) that may be influenced by the two different health-care systems. Patients were recruited from three sites (two in the US and one in England) as part of a National Institutes of Health funded study to examine outcomes of silicone metacarpophalangeal joint (MCPJ) arthroplasty in RA patients. Outcomes measurements included biomechanical assessments (grip strength, pinch strength, and mean ulnar drift and extensor lag at the MCPJs of all four fingers), a health-related quality of life questionnaire (the Michigan Hand Outcomes Questionnaire), and a medication assessment. American patients have a significantly higher income level (p < 0.001) and have completed higher levels of education (p < 0.001) than British patients. There were no significant differences in terms of self-reported disease severity or deformity at the MCPJs. RA patients in the US are more likely to take biologic medications (p < 0.001), steroids (p = 0.02), and Cox-2 inhibitors (p = 0.02). Patients in the UK are significantly more likely (p < 0.001) to take nonsteroidal anti-inflammatory drugs. There are differences in the demographic characteristics and medication use of RA patients with hand deformities in the US and UK. These differences may be influenced by the private versus socialized health-care systems. However, the perception of hand disease severity in participants in this study appears to be comparable between these countries.


Health-care systems Michigan Hand Outcomes Questionnaire Rheumatoid hand United Kingdom United States