One of the reasons of the wide variation in the management of RA in Japan might be due to the different behaviors between internists and orthopedists. To investigate this possibility, a survey was done at the 44th annual meeting of Japan Rheumatism Association in 2000.
Four hundred and ninety clinicians responded to our survey, including 212 internists and 252 orthopedists, respectively. In the management of RA, there was a wide difference between two groups. In particular, although both agreed that an appropriate communication between internists and orthopedists is necessary, half of the orthopedists answered that they don't refer their patients to internists. There was a wide variation in their ways of evaluations and prescribing behaviors. In particular, the use of DMARDs, both as monotherapy and combination, was significantly different between two groups.
There was a great difference in the management of RA by internists and orthopedists. These results might be associated with the outcome of RA patients in Japan. Dissemination of information concerning the management of RA, such as guidelines, as well as the establishment of a better health care system is necessary.