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. Method Eighteen patients aged ≥ 18 years old with active RA ( DAS 28 [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 ( RAPID 3) 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 RAPID 3 scores remained stable (all P  >   0.05 by anova ). Conclusion 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.