Pilot study assessing the novel use of musculoskeletal ultrasound in patients with rheumatoid arthritis to improve patient attitudes and adherence to medication.
OBJECTIVE
To determine if showing patients with rheumatoid arthritis (RA) ultrasound (US) images of their inflamed joints: (i) increased belief in the necessity of medication; (ii) encouraged patient activation, that is, confidence and understanding in managing their health; and (iii) facilitated medication adherence.


METHODS
Eighteen patients aged ≥ 18 years old with active RA (DAS28 [Disease Activity Score of 28 joints] > 2.6) requiring increased immunosuppression were included. The following questionnaires were administered at baseline (T1), 3 days post-US (T2) and 10 days post-US (T3): (i) Beliefs about Medicines Questionnaire (BMQ) to measure the cost-benefit analysis made by patients regarding the necessity versus concern of medication; (ii) Patient Activation Measure (PAM-13) to assess patient activation; (iii) Compliance Questionnaire-Rheumatology (CQR) to measure medication adherence; and (iv) Routine Assessment of Patient Index-3 (RAPID3) to assess physical function, pain and global status. US of ≥ 1 clinically affected joints was performed on one occasion with an explanation of findings.


RESULTS
Patient cost-benefit decisions shifted positively following US, that is, favored belief in the necessity of medication with a mean ± SD cost-benefit ratio (possible range - 20 to + 20) at T1 of 1.17 ± 6.10 which increased to 2.54 ± 5.38 at T2 and 4.06 ± 5.76 at T3, P = 0.043 by analysis of variance (anova). PAM-13, CQR and RAPID3 scores remained stable (all P > 0.05 by anova).


CONCLUSIONS
Showing patients with RA 'real-time' US images of clinically inflamed joints resulted in a more favorable cost-benefit analysis, that is, increased patient belief in the necessity of medication versus concern about taking medication. There was no change in patient activation, medication adherence or disease severity.
School of Health and Human Sciences, Southern Cross University, Coffs Harbour, New South Wales, Australia.
Samantha K
SK
Joplin
School of Health and Human Sciences, Southern Cross University, Coffs Harbour, New South Wales, Australia.
Rick
R
van der Zwan
Mid-North Coast Arthritis Clinic, Coffs Harbour, New South Wales, Australia.
Hanish
H
Bagga
Department of Rheumatology, Prince of Wales Hospital, Sydney, New South Wales, Australia.|University of New South Wales Prince of Wales Hospital Clinical School, Sydney, New South Wales, Australia.
Fred
F
Joshua
Mid-North Coast Arthritis Clinic, Coffs Harbour, New South Wales, Australia.|University of New South Wales Rural Clinical School, Coffs Harbour, New South Wales, Australia.
Peter K K
PK
Wong
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D018501:Antirheumatic Agents / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000000981:diagnostic imaging* / Q000188:drug therapy* / Q000191:economics / Q000523:psychology; D001296:Audiovisual Aids; D003362:Cost-Benefit Analysis; D016527:Drug Costs; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D007596:Joints / Q000000981:diagnostic imaging*; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D010147:Pain Measurement; D010353:Patient Education as Topic; D010865:Pilot Projects; D011237:Predictive Value of Tests; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler; D014796:Visual Perception
D018501:Antirheumatic Agents; D007166:Immunosuppressive Agents
adherence; attitudes; drug; rheumatoid arthritis; ultrasound