The results in smokers particularly caught Dr. Sparks’ attention. Although not statistically significant due to the low number of smokers in the study, more than half of those who smoked in the PRE-RA group quit smoking during the study. This was in stark contrast to not a single person giving up smoking in the non-intervention group.
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“For smoking, we thought this was a pretty powerful intervention,” he says. “It is typically very hard to convince people to give up smoking and more than half [of the group who] received PRE-RA had quit smoking six months after the intervention.”
The researchers noted that their findings may be applicable only to first-degree relatives of those with RA and not necessarily at risk for other chronic diseases. They also say that because the PRE-RA tool was adapted from a website developed to calculate personalized risk for other chronic conditions, a similar framework is likely to be relevant to other diseases, particularly because diet, smoking and obesity have an impact on many other illnesses.
Behavioral factors may be the only potentially modifiable risks for RA. Evidence that they can be changed could be a catalyst to larger intervention trials powered to find the specific effect of behaviors on actual RA risk or surrogate biomarkers.
Subjects were recruited at a single site and were mostly well-educated women, which may limit generalizability to other groups. Although the researchers performed a randomized, controlled trial, they were unable to blind subjects to the intervention they received due to its nature. It is possible that lack of blinding may have biased the outcome.
“In practice, we know there are behaviors related to RA risk,” says Dr. Sparks. “We have shown that telling people about their risk for RA really does change behaviors—and for the better. Although this doesn’t directly address whether these interventions change a person’s risk, we know these are healthy behaviors from many aspects.”
Kurt Ullman has been a freelance writer for more than 30 years and a contributing writer to The Rheumatologist for 10 years.
- Sparks JA, Iversen MD, Yu Z, et al. Disclosure of personalized rheumatoid arthritis risk using genetics, biomarkers, and lifestyle factors to motivate health behavior improvements: A randomized controlled trial. Arthritis Care Res. 2017 (in press).