"It was red, it was inflamed": A qualitative study of patient perspectives on musculoskeletal ultrasound in rheumatoid arthritis care.

Abstract

To explore the patient perspectives on musculoskeletal ultrasound (MSK-US)) and other visual tools in Rheumatoid Arthritis (RA) Care. A qualitative study enrolled patients with active disease who required a change of antirheumatic drugs. The rheumatologists discussed real-time MSK-US findings, including Doppler mode findings, according to predefined verbatim. Two anthropologists conducted semi-structured interviews exploring patients' perceptions of MSK-US and other visual tools. We included 25 patients (21 female, mean age 58.9 ± 11.6 years and mean 9.6 ± 5.7 synovitis score in MUS and 3.5 ± 2.6 score in Doppler mode. Twenty-three patients were interviewed. Five patients had medication adherence problems. The study revealed 3 themes: 1) Difficulties in formulating a mental picture of RA and little experience with visual tools; MUS findings were explained for the first time to most patients. 2) MSK-US images, especially in Doppler mode, heightened patients' awareness of the disease, and was better appreciated than other visual tools. 3) MSK-US explanations reinforced the therapeutic alliance. Viewing MSK-US images boosted motivation for treatment in adherent patients but was an incentive in only one patient with poor adherence. Explaining MSK-US images can help patients better understand their disease, enhance the patient-rheumatologist relationship and dialogue, and strengthen motivation for treatment. However, in cases of medication adherence problems, using MSK-US alone as a motivation tool seems insufficient. Rheumatologists could make a greater use of MSK-US as a communication tool to enhance therapeutic alliance with little extra time spent. The impact on medication adherence differs by level of adherence. Discovering inflamed joints in Doppler mode may be a motivation, but other strategies will be needed for patients with low adherence.