Abstract
BackgroundNon-adherence is a prevalent and modifiable issue in juvenile idiopathic arthritis (JIA) that currently lacks provider-based intervention. Education surrounding disease status is one way in which families remain engaged in their care. Musculoskeletal ultrasound is one such form of demonstrative, real-time education that may impact the way patients and caregivers self-manage their disease. The aims of this study are to 1) assess the feasibility, acceptability and perceived usefulness of musculoskeletal ultrasound as a non-adherence intervention tool and 2) to examine changes in methotrexate adherence in adolescents with JIA following the ultrasound.MethodsEight adolescents with polyarticular or extended oligoarticular JIA and their caregivers completed this 12 week study. A within subject design was used to compare baseline and post-intervention adherence, quality of life and disease activity indices. Adherence measures included electronic measurement of methotrexate in addition to self-reported adherence questionnaires. The ultrasound intervention included a one-time, rheumatologist provided, educational examination of three or more currently or historically active joints.ResultsThe ultrasound intervention was found to be both feasible and acceptable. One hundred percent of eligible participants completed the ultrasound intervention. The ultrasound was well received by patients and caregivers, with most believing this to be a helpful tool. Baseline adherence was 75.3% among participants, with half of the participants being classified as non-adherent. Electronically measured and self-reported adherence measures did not show significant changes during the post-intervention period. Two participants improved, four participants maintained, and two participants decreased adherence. On ultrasound, 18/27 (66.7%) of the examined joints displayed abnormalities, with 63% being discrepant and additive to the rheumatologist’s physical examination.ConclusionsWhile our intervention did not show any changes in adherence, quality of life or disease activity indices in this proof-of-concept trial, the intervention does show promise in acceptability measures and merits future study in a more robust trial design. An additional study benefit was that the musculoskeletal ultrasound intervention was able to demonstrate subclinical disease, leading to clinically impactful therapeutic changes in several participants.
Highlights
Non-adherence is a prevalent and modifiable issue in juvenile idiopathic arthritis (JIA) that currently lacks provider-based intervention
Studies focused on patients with polyarticular Juvenile Idiopathic Arthritis (JIA) indicate that early and aggressive therapeutic approaches increased the likelihood of attainment and maintenance of disease remission [2, 3]
Adherence was capped at 100% for all analyses [20, 34]. Because this is a proof-of-concept study, we examined descriptive information and used basic statistical tests to examine pre-post changes in electronically-monitored and self/parent-reported adherence
Summary
Non-adherence is a prevalent and modifiable issue in juvenile idiopathic arthritis (JIA) that currently lacks provider-based intervention. Musculoskeletal ultrasound is one such form of demonstrative, real-time education that may impact the way patients and caregivers self-manage their disease. Juvenile Idiopathic Arthritis (JIA) is the most common rheumatic condition affecting children worldwide, with an estimated prevalence rate of 132 per 100,000 [1]. Studies focused on patients with polyarticular JIA indicate that early and aggressive therapeutic approaches increased the likelihood of attainment and maintenance of disease remission [2, 3]. Even after remission is attained, the current risk of disease recurrence reaches approximately 40%, which in part may be due to waning treatment adherence [4]
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