435age, and cartilage abnormalities—would help the patients understand the need for
medical or surgical management and the reasons behind changing their medication
type or dose. In addition, the visualization of severity of the disease activity or joint
damage using musculoskeletal US would have a positive impact on patient-centered
outcomes such as belief in the necessity of medication, activation (i.e., engagement
with therapy), and medication adherence in patients with RA. This was assessed
recently in a study [ 82 ] that included 18 patients with active RA (DAS-28 > 2.6)
who require increased immunosuppression. At baseline, 3 and 10 days post US
every patient completed three different questionnaires including: (1) Beliefs about
Medicines Questionnaire (BMQ) to measure the cost-benefi t analysis made by
patients regarding the necessity versus concern of medication; (2) Patient Activation
Measure (PAM-13) to assess patient activation; and (3) Compliance Questionnaire-
Rheumatology (CQR) to measure medication adherence. In addition, every patient
was assessed clinically and patient reported outcome measures were recording for
physical function, pain, and global status. Results revealed that showing the patients
“real-time” US images of their clinically infl amed joints on one occasion reduced
patient concerns regarding escalation of immunosuppression, while maintaining a
positive and stable belief in the necessity of medication as assessed by the Beliefs
about Medicines Questionnaire. This resulted in patients’ cost-benefi t analyses
shifting in favor of the benefi ts (or necessities) of pharmacotherapy. Stable disease
activity score and patient outcome measures during the study suggested that the
observed change in the Beliefs about Medicines Questionnaire scores was not due
to fl uctuation in disease severity. The authors concluded that it is heartening that a
simple intervention of one 20-min US session with the treating rheumatologist
appeared to be an effective patient educational tool that was associated with a reduc-
tion in patient concerns about medication. This is particularly important in RA as
patient levels of concern are high and associated with medication non-adherence
and helplessness [ 83 ]. Table 18.2 includes the main studies carried out to assess the
relation between MSUS-synovitis assessment and patient reported outcome mea-
sures in rheumatoid arthritis patients at different disease stages [ 50 , 60 , 67 , 68 , 82 ].
Ultrasound-Guided Procedures and Patient Reported
Outcome Measures
US offers a real-time visual aid helping to carry out a quick, safe, and precise intra-
articular or soft tissue procedures. Furthermore, US enables the treating health care
professional to see beneath the skin’s surface, make immediate care decisions, and
avoid or minimize complications. In some cases, this added information has changed
the course of action or treatment completely. Several studies were carried out com-
paring the accuracy of blind versus US-guided procedures and systematic meta-
analysis studies repeatedly gave the privilege to US-guided procedures [ 84 – 87 ].
However, outcomes of any interventional procedure is mainly “patient” based,
18 PROMs and Musculoskeletal Ultrasonography