Is Rheumatoid Arthritis Preventable?

Some risk factors for RA can be controlled, when patients are motivated.
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Is rheumatoid arthritis (RA) preventable? Results of a newly published study suggest that personalized medicine approaches may result in health behavior that may reduce RA risk.

“We have gotten to the point where we’ve identified some modifiable behaviors that affect rheumatoid arthritis risk,” says Jeffrey A. Sparks, MD, MMSc, assistant professor of medicine in the Division of Rheumatology, Immunology and Allergy at Brigham and Women’s Hospital in Boston. “We have made a lot of progress in observational studies to identify risk factors for RA, and the next step is trying to target prevention strategies for those at risk.”

Randomized, Controlled Trial

Dr. Sparks, Elizabeth Karlson, MD, MPH, and other colleagues performed a randomized, controlled trial among 238 first-degree relatives of patients with RA.¹ Participants were assigned to one of three arms, the Personalized Risk Estimator for RA (PRE-RA) arm, a PRE-RA plus health counseling arm or a comparison arm that received standard RA education.

PRE-RA was an educational intervention adapted from Your Disease Risk. The 78 participants in this arm received a Web-based tool that collected information on demographics, family history and behavioral risk factors, as well as certain genetic variables and the presence of RA-related autoantibodies.

This tool provided educational information personalized for the individual based on their specific risk factors and background. It included a visual presentation of that person’s risks along with specific tips on how to modify their behavioral factors.

The PRE-RA Plus group of 80 subjects also received the tool. They were given an additional 45-minute one-on-one session with a health educator to facilitate interpretation of the results and educate the participant on both their specific risks and risk-related behavioral changes suggested.

The comparison arm consisted of 80 subjects. They received standard education about RA epidemiology, symptoms and diagnosis during a one-on-one session with handouts.

Innovative Design

“This study has an innovative design,” says Dr. Sparks. “We built an interactive RA-specific risk calculator giving those first-degree relatives a personalized risk assessment, displaying both relative risk and lifetime risk for RA. We then asked if disclosing this personalized RA risk information would have an impact on their risky behaviors related to RA.”

Subjects completed questionnaires on sociodemographics, risk behavior, concerns, decision-making processes and healthcare utilization at baseline, immediately after the RA educational intervention and then six weeks, six months and 12 months afterward. All received booster education identical to their baseline intervention after completing the six-month follow-up visit.