Background/Purpose: Musculoskeletal ultrasound (MSKUS) is a valuable tool for early detection and management of inflammatory arthritis.(1) Although integrated into rheumatology guidelines, training programs, and classification criteria, its impact on patient perceptions and shared decision-making is underexplored.(2, 3) We hypothesized that MSKUS improves patient understanding of disease and enhances provider confidence in management.

Methods: This prospective cohort study at 2 academic centers enrolled patients with undifferentiated joint pain referred for MSKUS between August 2023 and June 2024. Institutional review board (IRB) approval was obtained at one site and deemed exempt at the other. Patients completed pre- and post-MSKUS visit surveys assessing understanding of joint pain etiology, perceived need for treatment change, evaluation thoroughness, and treatment adherence likelihood. Referring providers completed pre- and post-surveys on MSKUS indication, immunosuppression, confidence in treatment plan, and perceived MSKUS utility. Responses, recorded on a 5-point Likert scale, were analyzed using descriptive statistics and paired t-tests.

Results: A total of 109 patients and 53 provider surveys were analyzed. Table 1 shows the rheumatologic disease diagnoses and MSKUS referral indications. The mean scores and standard deviations (SD) for key outcomes are as follows: Post-MSKUS, understanding of the ultrasound purpose significantly improved, with scores (1 = very poorly, 5 = very well) increasing from 4.339 (SD = 0.841) to 4.688 (SD = 0.588), p < 0.001. Understanding of joint pain cause improved, with scores rising from 3.449 (SD = 1.312) to 4.046 (SD = 1.109), p < 0.001. Most patients felt their problem had been more thoroughly examined (94.4%) and reported to be more likely to adhere to their provider’s treatment plan (75.7%). Post-MSKUS, patients were less likely to feel a need for treatment change, with scores (1 = much less likely, 5 = very much more likely) decreasing from 3.542 (SD = 1.215) to 3.187 (SD = 1.326), p = 0.006. There was a modest decline in attributing joint pain to rheumatic disease, with scores (1 = very much unrelated, 5 = very much related) decreasing from 3.876 (SD = 1.253) to 3.578 (SD = 1.321), p = 0.047. Among 15 referring providers reporting on 53 patients referred for MSKUS, confidence in treatment plans increased from 3.415 (SD = 0.795) to 4.792 (SD = 0.454), p < 0.001. with 32.1% changing management based on ultrasound findings.

Conclusion: Real-time MSKUS is an effective educational tool that supports shared decision-making and strengthens provider confidence in personalized treatment planning. These findings support its broader integration into routine rheumatologic care.References:References1. Cannella AC KE, Torralba KD, Higgs JB, Kaeley GS. Evolution of musculoskeletal ultrasound in the United States: implementation and practice in rheumatology. Arthritis Care Res 2014.2.Patil P DB. Role of diagnostic ultrasound in the assessment of musculoskeletal diseases. Musculoskeletal Dis. 2012.3. Płaza M N-PA, Pracoń G, Sudoł-Szopińska I. Role of ultrasonography in the diagnosis of rheumatic diseases in light of ACR/EULAR guidelines. J Ultrason. 2016.

Table 1: Rheumatologic diagnosis and purpose of musculoskeletal ultrasound (MSKUS) referral.

Figure 1: Effect of musculoskeletal ultrasound on patient perceptions.

Figure 2: Effect of musculoskeletal ultrasound on provider treatment plans.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/musculoskeletal-ultrasound-enhances-patient-insight-and-clinical-decisions-a-multi-center-study/