Background/Purpose:

To assess the value of sharing the real-time ultrasound (US) images of the inflamed joints/ tendons with inflammatory arthritis patients and its impact on: 1. patient motivation; 3. medication adherence; 3. Control of disease activity; and 4. Patient cost-benefit decision.

Methods:

Observational longitudinal study which included 121 patients, diagnosed to have active RA (62-patients, DAS-28 >3.2), or psoriatic arthritis (59-patients) who were treated according to Treat-to-Target approach. At baseline, 3-, 6- and 12-month every patient completed: A. PROMs questionnaire [1]; B. Beliefs about Medicines Questionnaire (BMQ) [2] to assess the cost-benefit analysis made by patients regarding the necessity versus concern of medication; C. Patient Motivation Measure [3]; D. Compliance Questionnaire-Rheumatology (CQR) [4] to measure medication adherence. US joint/ soft tissue examination was carried out based on patient reported joint/ enthesitis tenderness. All the US findings which were explained through direct clinician-patient interaction. Scores of US disease activity were recorded semi-quantitatively.

Control group: 118 of age and sex matched group of patients living with inflammatory arthritis (61 RA and 57 Psoriatic arthritis) treated per Treat-to-Target in standard outpatient setting. The patients were subjected to the same clinical assessment and completed the same questionnaires at the same time intervals. However, they were not subjected to US guided education.

Appropriate tests of significance were used to compare the study statistics. Pearson correlation coefficients were used to test the relationship between patient beliefs and medication adherence.

Results:

Incorporation of US-guided patient education improved patient motivation and adherence to therapy. Patient motivation scores showed the highest significant changes in response to the US-guided education at 3-, 6-, and 12-months of follow up (p< 0.001). This was paralleled by similar significant improvement in the DAS-28 score (P < 0.01) at both 3- and 6-months of follow up.

Patient cost-benefit decisions shifted positively in the group who had US guided education. The shift was in favour of “belief in the necessity” of medication with a mean ± SD cost-benefit ratio at 3-month of 2.72±3.41 which increased at 6-month to 4.92±4.84, whereas at 12-month 9.83±4.62, P = 0.01. Similar improvement was noted in the CQR score as well as functional disability and quality of life measures.

Conclusion:

US-guided patient education helped to improve the patient motivation and those patients with better understanding of the treatment benefits were more inclined to accept risks in the pursuit of successful disease control. Results highlighted that inflammatory arthritis patients who were well informed about the risks and benefits of medication showed better cost-benefit analyses. The patients would be more adherent to medication if they visualized the necessity of medication outweighed concerns about adverse effects.

References:

1. El Miedany et al. Clin Exp Rheumatol 2010; 28(5):734-44
2. Horne R et al. J Health Psych 1999; 14: 1 –24
3. El Miedany et al. Clin Rheumatology 2017. doi: 10.1007/s10067-017-3605-x.
4. De Klerk E et al. J Rheumatol 2003; 30: 2469–75.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/patient-motivation-in-inflammatory-arthritis-the-use-of-ultrasound-guided-patient-education-to-endorse-medication-adherence-and-facilitate-cost-effective-targeted-management/