Factors Associated With Treatment Decision of Ultrasound in Rheumatoid Arthritis

In outpatients with rheumatoid arthritis (RA), both the physician experience level and disease activity level affect the impact of musculoskeletal ultrasound (MUS) on treatment decisions, according to study results published in the Journal of Clinical Rheumatology.

The study included clinical vignettes that summarized data from outpatients with RA (n=16). The vignettes initially included clinical evaluation and a space for a first treatment proposal. Then, MUS information was added based on German Ultrasound score, and a space for treatment reconsideration was provided if necessary.

Over a period of 6 months, vignettes were concomitantly presented to 6 trainees and 6 senior rheumatologists. The participant clinicians were blinded to other participants’ responses.

The vignettes included data on women patients with a mean ± standard deviation (SD) age of 43.3±9 years. Mean disease duration was 7.6±3.5 years, and 68.8% of the patients had comorbidities.

After adding MUS information, 24% of evaluations suggested treatment modification, with similar percentages in trainees and senior rheumatologists.

Of the trainees, the rate of MUS-induced treatment modification was similar between evaluations from 1st year trainees (22.6%) and 2nd year trainees (23.2%).

Of the senior rheumatologists, more experienced rheumatologists (≥15 years of experience) never proposed a different treatment after MUS findings. Senior rheumatologists with less experience proposed different treatments after MUS findings in 34% of cases (P ≤.0001).

The results indicated that MUS-induced treatment modifications happened more frequently in patients with low and moderate disease activity compared with patients with remission and high disease activity (P =.008).

“These clinical statuses may identify RA patients in whom additional MUS assessments should be implemented,” the researchers wrote.

Reference Sifuentes-Cantú C, Contreras-Yáñez I, Gutiérrez M, et al. Physician’s experience and disease activity affect the impact of ultrasound on the treatment decision in rheumatoid arthritis [published online April 12, 2019]. J Clin Rheumatol. doi:10.1097/RHU.0000000000001036