title: The impact of using musculoskeletal ultrasound imaging and other influencing factors on medication adherence in patients with rheumatoid arthritis: a qualitative study.
abstract: BACKGROUND
  Medication can ease symptoms and limit disease progression in rheumatoid arthritis (RA). Despite this, nonadherence to medication is common in RA. We explored the determinants of high and low adherence to disease-modifying antirheumatic drugs (DMARDs) in patients with RA and provide suggestions on approaches to improving adherence to DMARDs.
  
  
  METHODS
  Patients with RA were identified from those who had previously participated in a questionnaire measuring levels of medication adherence. Twenty patients participated (ten high and ten low adherers, as determined by responses to the Medication Adherence Report Scale). In-depth individual semistructured interviews were undertaken until data saturation was reached. Interviews were transcribed and analyzed using a constant comparative method.
  
  
  RESULTS
  Four main themes related to adherence were identified: 1) symptom severity; 2) illness perception; 3) perceived benefits and risks of DMARDs; and 4) the quality and quantity of information about RA and DMARDs. In addition, patients' suggestions about strategies to optimize adherence to DMARDs were captured and they fell within the following themes: 1) musculoskeletal ultrasound to explain the disease process and to provide objective feedback about the extent to which their disease activity is being effectively controlled; 2) better explanations of the consequences of poorly controlled RA; and 3) a good relationship with the health professional.
  
  
  CONCLUSIONS
  Patients' beliefs about medicines, perceptions about RA, and level of satisfaction with information about DMARDs influenced their adherence to DMARDs. The use of musculoskeletal ultrasound to image the inflamed joint may help to improve patient adherence to DMARDs.
authors.affiliation: Primary Care Clinical Sciences, University of Birmingham, Birmingham, UK; Faculty of Medical and Human Sciences, University of Manchester, Manchester, UK.
authors.forename: Kanta
authors.initials: K
authors.lastname: Kumar
authors.affiliation: Institute of Inflammation and Ageing, University of Birmingham, UK; Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK.
authors.forename: Karim
authors.initials: K
authors.lastname: Raza
authors.affiliation: Primary Care Clinical Sciences, University of Birmingham, Birmingham, UK.
authors.forename: Paramjit
authors.initials: P
authors.lastname: Gill
authors.affiliation: Primary Care Clinical Sciences, University of Birmingham, Birmingham, UK.
authors.forename: Sheila
authors.initials: S
authors.lastname: Greenfield
keywords: disease-modifying antirheumatic drugs; medication adherence; patients’ suggestion to improve medication; rheumatoid arthritis