Preventive treatment of Rheumatoid Arthritis is personal


Rheumatoid arthritis, or RA for short, is a chronic inflammatory joint disease causing pain, swelling, stiffness and fatigue, as well as joint damage and disability. There is currently no cure for RA, and long-term treatment with immunomodulatory drugs is usually required. Early treatment, within a few months of symptom onset, improves patient outcomes. Clinical trials are currently investigating whether short-term treatment in people who are at risk of developing RA can delay the onset of the disease or lower the chance of it developing altogether. With increasing interest in preventive treatment in RA, PREFER researchers have explored why people at risk of RA may or may not consider taking medication for this purpose.

There is a lot of interest in the idea of taking preventative action and treating people who are at risk of developing RA, with a relatively short course of therapy, which might lower their risk of developing the disease and needing long term treatment. But before developing new treatment approaches like this, it is essential to understand the views of those who might be offered preventive treatment for RA on the benefits and risks of the treatment.

In a recent paper published in the Scandinavian Journal of Rheumatology, PREFER researchers explore the treatment preferences of the first-degree relatives of people with RA, as well as members of the public through focus groups or interviews. Participants were asked to imagine that they had been experiencing joint pains and a blood test had shown they were at high risk of developing RA and were asked discuss their preferences for preventive treatment. Important considerations for participants in the study were attributes of the treatment such as its effectiveness, or potential for serious side effects, which are often the focus of treatment preference studies. However, participants also described how their decision making about taking a treatment to prevent RA would be influenced by their personal experiences and circumstances, just as much as the characteristics of the treatment itself, and sometimes perhaps more so.

“Weighing up the risks and benefits of a new treatment option can be very challenging, and often involves understanding a great deal of complex information. Educational tools and resources are a great tool to support this. But educational materials need to take more than just the treatment aspects into account. Some patients will be mostly concerned with treatment features such as efficacy of the treatment, how the treatment is administered or side effects, or other treatment related aspects such as cost. But there are other, circumstantial factors or personal characteristics that affect whether or not a person is interested in preventive treatment, such as age, family history of RA and   a person’s attitudes towards taking medication in general” says Gwenda Simons, Research fellow at the University of Birmingham, and one of the authors.

This highlights the importance of addressing non-treatment related factors in the development of personalised tools to support decision-making by participants in patient preference studies, those considering taking part in RA prevention trials, and to enable shared decision making about future treatments by patients and healthcare professionals.

Want to read the paper? G Simons, K Schölin Bywall, M Englbrecht, EC Johansson, RL DiSantostefano, C Radawski, J Veldwijk, K Raza & M Falahee (2022) Exploring preferences of at-risk individuals for preventive treatments for rheumatoid arthritis, Scandinavian Journal of Rheumatology, DOI: 10.1080/03009742.2022.2116805

By Anna Holm

Last modified: 2021-11-10