SAT0553 HIGH FEASIBILITY AND ACCEPTANCE OF A MUSCULOSKELETAL ULTRASOUND PROGRAM TO IMPROVE DMARDS ADHERENCE IN RHEUMATOID ARTHRITIS

Abstract

Background Disease modifying anti-rheumatic drugs (DMARDs) non-adherence is a widespread issue in rheumatoid arthritis (RA) which needs to be urgently addressed as it can lead to suboptimal therapy with poor disease outcomes. The subsequent need for more aggressive therapy, treatment of disease related complications and increased consultations can translate into increased healthcare utilization and costs. Objectives To describe the feasibility and patient’s acceptance of a Musculoskeletal Ultrasound Program (MUSP) developed to improve DMARDs adherence in RA patients who are non-compliant to their conventional DMARDs (Methotrexate, Leflunomide, Sulfasalazine and/or Hydroxychloroquine) therapy. Methods The MUSP is a standardized approach (i.e. each patient given the same standardized intervention) which synergises (1) the patients’ direct visualization of their joint pathologies (inflammation and/or erosions) using real-time ultrasonography and (2) a Rheumatologist’s simultaneous reinforcement of the need for medication adherence, thereby improving patient’s understanding of their joint disease and motivating them to adhere to their DMARDs therapy. Joints utilized to demonstrate joint pathologies real-time were clinically affected ones. In the event that a specific joint pathology is not demonstrable on ultrasonography, the subject will be shown a representative picture of an ultrasound lesion corresponding to that specific joint pathology. Patient acceptability was assessed using questionnaire administered by an interviewer who is not the Rheumatologist conducting the MUSP. Categorical variables were reported using frequency counts and percentages, while continuous variables using mean and standard deviation (SD). Results 62 RA patients (baseline characteristics: majority Chinese, 40/62 (64.5%); 55/62 (88.7%) female; mean (SD) age, 49.2 (12.0), mean (SD) DAS28, 3.27 (1.39); mean (SD) disease duration, 6.1 (5.4) years) completed the MUSP. The mean (SD) time taken to complete the MUSP was 9.2 (4.6) minutes. All patients had at least one joint pathology demonstrable to them on real-time ultrasonography. Specifically, 62/62 (100%), 14/62(22.6%) and 25/62 (40.3%) had demonstrable synovial hypertrophy, power Doppler synovial vascularity and bone erosions, respectively. Figure 1 shows the frequency distribution of the joint sites utilized to demonstrate joint pathologies real-time using ultrasonography. The majority of patients reported that the MUSP had moderately or very much improved their understanding of their underlying joint condition (i.e. 44/62 (71.0%) patients) and the importance of regularly taking their RA medication (i.e. 49/62 (79.0%) patients) (figure 2). Most patients (i.e. 56/62 (90.3%) patients) will also recommend the MUSP to another RA patient. Conclusion Our results demonstrated high feasibility and acceptance of a MUSP developed to improve DMARDs adherence in RA patients. Further studies are required to establish the clinical impact and cost-effectiveness of the MUSP in this population.