Purpose: To evaluate physicians' beliefs about the effectiveness of common rheumatoid hand procedures.

Methods: We mailed a survey instrument to a random national sample of 500 rheumatologists and 500 hand surgeons (53% response rate), in order to describe beliefs about the effectiveness of common rheumatoid hand procedures.

Results: Only 15% of rheumatologists believe that quality evidence exists regarding rheumatoid hand surgery, and 70% consider hand surgeons deficient in knowledge pertaining to the medical options for RA. Surgeons are similarly critical, as 64% perceive rheumatologists as being too passive in managing RA hand deformities, and 79% find the timing of rheumatologists' referrals inappropriate. The two physician groups significantly disagree on the effectiveness of all procedures included in the survey. Comparing hand surgeons to rheumatologists, 82.5% vs. 34.1% believe metacarpophalangeal joint arthroplasty improves hand function; 93.2% vs. 54.6% believe prophylactic extensor tenosynovectomy prevents tendon rupture; and 52.5% vs. 12.6% believe small joint synovectomy delays joint destruction (all p< 0.001).

Conclusions: Rheumatologists view rheumatoid hand surgery as significantly less effective than do hand surgeons, highlighting the disagreements between the two specialties. Future research needs to focus on surgical outcomes studies and improved communication between the two specialties to development a unified treatment strategy.