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. 2018 Nov 22;16(1):75.
doi: 10.1186/s12969-018-0292-3.

Feasibility of a musculoskeletal ultrasound intervention to improve adherence in juvenile idiopathic arthritis: a proof-of concept trial

Leslie A Favier  1   2 , Tracy V Ting  3 , Avani C Modi  4
Affiliations

Feasibility of a musculoskeletal ultrasound intervention to improve adherence in juvenile idiopathic arthritis: a proof-of concept trial

Leslie A Favier et al. Pediatr Rheumatol Online J. .

Abstract

Background: Non-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.

Methods: Eight 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.

Results: The 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.

Conclusions: While 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.

Keywords: Adherence; Juvenile idiopathic arthritis; Musculoskeletal ultrasound.

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Conflict of interest statement

Ethics approval and consent to participate

This study received Institutional Review Board Approval (#2016–9219) through Cincinnati Children’s Hospital Medical Center.

Consent for publication

All 11 adolescents who were enrolled completed a written assent and their respective caregivers completed a written consent to participate and have this work published.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
CONSORT Diagram
Fig. 2
Fig. 2
Participant Adherence Trajectory. Legend: Adherence is represented as the percentage of methotrexate dosages administered via MEMs TrackCap over the total prescribed treatment regimen doses. Adherence goal range is classically above 80%. Dashed lines represent overlapping participant data
Fig. 3
Fig. 3
Ultrasound Intervention Findings. Legend: This figure demonstrates the location and description of the ultrasound findings by joint. SH- Synovial Hypertrophy
See this image and copyright information in PMC

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