title: Differences between the United States and the United  Kingdom in the treatment of rheumatoid arthritis: analyses  from a hand arthroplasty trial.
abstract: 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.
authors.affiliation: Department of Surgery, University of Michigan Health System, Ann Arbor, MI 48109-0340, USA. kecchung@med.umich.edu
authors.forename: Kevin C
authors.initials: KC
authors.lastname: Chung
authors.forename: Sandra V
authors.initials: SV
authors.lastname: Kotsis
authors.forename: David A
authors.initials: DA
authors.lastname: Fox
authors.forename: Marian
authors.initials: M
authors.lastname: Regan
authors.forename: Frank D
authors.initials: FD
authors.lastname: Burke
authors.forename: E F Shaw
authors.initials: EF
authors.lastname: Wilgis
authors.forename: H Myra
authors.initials: HM
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001172:Arthritis, Rheumatoid / Q000188:drug therapy / Q000453:epidemiology* / Q000601:surgery; D001178:Arthroplasty; D004739:England / Q000453:epidemiology; D005260:Female; D006225:Hand / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D009313:National Health Programs; D012219:Rheumatology / Q000458:organization & administration; D012720:Severity of Illness Index; D012959:Socioeconomic Factors; D014481:United States / Q000453:epidemiology; D055815:Young Adult