Oral and Poster Presentation ARA-NSW 2021 - 43rd Annual NSW Branch Meeting

Does “real-time” ultrasound improve patient medication adherence and increase patient willingness to take Disease Modifying Anti-Rheumatic Drugs in the treatment of inflammatory arthritis? (#4)

Carmella Gunasingam 1 , Kanta Kumar 2 , Sheila Greenfield 3 , Chris Armitage 4 , Robert Horne 5 , Peter K Wong 1 6 7
  1. Department of Rheumatology, Westmead Hospital, Sydney, NSW, Australia
  2. Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
  3. Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
  4. Manchester Centre for Health Psychology, University of Manchester, Manchester, United Kingdom
  5. UCL School of Pharmacy, University College London, London, United Kingdom
  6. Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
  7. Rural Medical School, University of New South Wales, Coffs Harbour, NSW, Australia

Background: Patient medication adherence with DMARDS in RA and PsA remains sub-optimal. Poor patient understanding of the morbidity and mortality associated with uncontrolled inflammatory arthritis may result from limited appreciation of joint structures and sequelae of joint damage and inflammation. Musculoskeletal (MSK) ultrasound allows visualisation of joint structures in “real-time”, is useful in assessment of synovitis and joint structures and may be useful as a patient educational tool.

Aim: To determine if real-time ultrasound of inflamed joints in a patient with active RA or PsA (i) increases patient willingness to take an additional DMARD (conventional synthetic, biologic or targeted synthetic), and ii) improves patient medication adherence with these agents.

Methods: Patients ≥ 18 years old with RA or PsA with disease duration <5 years that is incompletely controlled (DAS 2.6-5.1) despite a conventional synthetic DMARD for ≥ 3 months, where willingness to escalate immunosuppression is ≤50 on an anchored visual analogue scale (VAS) will be included. Patients will undergo 1:1 randomisation to either 1) standard care involving a 30-minute education session with a rheumatology healthcare professional  and provision of an Australian Rheumatology Association Medication Information Sheet, or 2) a 30-minute MSK ultrasound session of clinically involved joint(s) by a trained rheumatologist, with explanation of sonographic findings. Baseline data including demographics, DAS28-ESR and Newest Vital Sign (a measure of health literacy) will be collected. Primary outcome will be medication adherence as assessed by the Compliance Questionnaire-Rheumatology (CQR). Secondary outcomes include the Medication Adherence Rating Scale, patient willingness to escalate immunosuppression on VAS, Multi-Dimensional Health Assessment Questionnaire, Brief Illness Perception Questionnaire, Beliefs about Medicine Questionnaire, EQ-5D-5L and patient-recorded experience of their session. Using a two-tailed test with significance level of 0.05, a sample size of 34 patients per group provides 90% power to detect a difference of 10 points on the CQR with standard deviation of 12.54. Allowing for a 20% drop out rate, we aim to recruit 40 patients per group.

Results: To follow.