For this cross-sectional study, researchers wanted to determine which factors influence the impact of musculoskeletal ultrasound (MUS) on treatment recommendations among rheumatologists of varying experience levels. Sixteen clinical vignettes presented data from RA outpatients; vignettes contained clinical examination and a blank area for a first therapy recommendation; MUS information was then included, based on the German Ultrasound score, followed by a blank part for treatment re-consideration, if relevant. Each vignette was shown concurrently to six trainees and six senior rheumatologists (SR) throughout a 6-month period; three of the SR had 15 years of experience. The responses of coworkers were hidden from participants. Statistics were chosen with care.
Data from female patients with a mean ± SD age of 43.3 ± 9 years, an illness duration of 7.6 ± 3.5 years, and comorbidities (68.8%). MUS caused treatment adjustment in 24% of assessments, with a similar percentage in SR and trainees. Within SR, more experienced rheumatologists (≥15 years) never converted MUS results into a new therapy plan, but 34% of those with less experience did, p ≤ 0.0001. There were 60 clinical situations with remission and moderate disease activity each, as well as 36 clinical scenarios with low and high disease activity. MUS-induced treatment adjustments were more likely in cases of low and moderate illness activity vs remission and high disease activity, p = 0.008.
The impact of MUS on treatment decisions in RA outpatients is influenced by the physician’s experience and disease activity level. MUS inclusion into conventional examinations may aid RA patients with moderate disease activity.
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