A musculoskeletal ultrasound program as an intervention to improve disease modifying anti-rheumatic drugs adherence in rheumatoid arthritis: a randomized controlled trial

Abstract

Objectives: To evaluate the effect of a musculoskeletal ultrasound programme (MUSP) applying real-time ultrasonography with reinforcement of findings by a rheumatologist on improving disease-modifying anti-rheumatic drugs (DMARDs) adherence in rheumatoid arthritis (RA).

Method: Eligible RA patients with low adherence score (< 6) on the 8-item Morisky Medication Adherence Scale (MMAS-8) were randomized to either an intervention group (receiving MUSP at baseline) or a control group (no MUSP), and followed up for 6 months. Adherence measures (patient-reported and pharmacy dispensing records) and clinical efficacy data were collected. The MUSP’s feasibility and acceptability were assessed.

Results: Among 132 recruited RA patients, six without baseline visits were excluded; therefore, 126 patients were analysed (62 intervention and 64 control). The primary outcome (proportion of patients with 1 month MMAS-8 score < 6) was significantly smaller (p = 0.019) in the intervention (35.48%) than the control group (56.25%). However, 3 and 6 month adherence and clinical efficacy outcomes were not significantly different between the two groups (all p > 0.05). All 62 patients completed the MUSP (mean time taken, 9.2 min), with the majority reporting moderately/very much improved understanding of their joint condition (71%) and the importance of regularly taking their RA medication(s) (79%). Most patients (90.3%) would recommend the MUSP to another RA patient.

Conclusions: The MUSP improved RA patients’ DMARDs adherence in the short term and was feasible and well accepted by patients. Future studies could evaluate whether repeated feedback using MUSP could help to sustain the improvement in DMARD adherence in RA patients, and whether this may be clinically impactful and cost-effective.

Acknowledgements

We thank colleagues and staff from the study site for the support and help provided in this study. We thank Li Min Ng for assisting in the preparation of the manuscript. We thank Sow Ling Yee and Rong Fang Zhang for assisting as clinical joint assessors. Use of the ©MMAS is protected by US copyright and registered trademark laws. Permission for use is required. A license agreement is available from: Donald E. Morisky, MMAR LLC, 294 Lindura Court, Las Vegas, NV 89138-4632; [email protected]

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This research is supported by the Singapore Ministry of Health’s National Medical Research Council under its Transition Award [NMRC/TA/0043/2015]. Any opinions, findings, and conclusions or recommendations expressed in this material are those of the author(s) and do not reflect the views of MOH/NMRC.