Rheumatiod arthritis: Treatment options

Rheumatoid arthritis (sometimes called “RA”) is a common chronic inflammatory disease that affects around 1% of the population. It is 3-4 times more common in women. In most cases, patients begin having symptoms between 40 to 60 years of age, but it can begin earlier, or later in life.

RA affects the joints and causes pain, swelling, and stiffness, but also fatigue. If patients are not treated, the joints can suffer permanent damage, which subsequently can lead to disability. To date, there is no cure, which means that all treatments are long term, with the aim to control the inflammatory disease activity and reduce symptoms.

There is a number of disease-modifying antirheumatic drugs on the market known as DMARDs. These drugs target the inflammation in different ways, and there are some practical differences for the patient: How they take the drug, how often they need to take it, different risks of side effects and tests they need to take.

When someone is first diagnosed with RA, they often start treatment with conventional drugs known as ‘synthetics’ (or csDMARDs). If treatment doesn’t work, or if there are too many side-effects, patients often needs to step up treatment to ‘biologics’ (known as bDMARDs), or what is known as ‘targeting synthetics’, also known as JAK-inhibitors (or tsDMARDs). These drugs target specific biological mechanisms that are associated with the start and progression of inflammation. The side effect and the long-term outcomes are well known for older biologics. However, the JAK-inhibitors recently became available so there is still uncertainty in adverse events and the long-term outcomes.

Treatments affect patient’s quality of life. Finding the best treatment for patients with RA that need to change their medication means choosing from a number of drugs with different side effects and practical considerations. Like if patients prefer pills, injections or intravenous treatment. Or how often they are willing to take the drug.

We want to explore the preferences of patients with RA to find out what trade-offs they are willing to make for treatments with JAK-inhibitors compared to biologics, to support clinical and regulatory decisions in deciding which treatment is best suited for patients.


Schölin Bywall K, Veldwijk J, Hansson MG, Baecklund E et al, Does being exposed to an educational tool influence patient preferences? The influence of an educational tool on patient preferences assessed by a discrete choice experiment., Patient Education and Counseling, 10 March 2021

Schölin Bywall K, Veldwijk J, Hansson MG, Kihlbom U et al, Patient Perspectives on the Value of Patient Preference Information in Regulatory Decision Making: A Qualitative Study in Swedish Patients with Rheumatoid Arthritis, 2019:12; 297-305

Schölin Bywall K, Veldwijk J, Hansson MG, Kihlbom U et al, Rheumatoid Arthritis Patients’ Perspectives On The Value Of Patient Preferences In Regulatory Decision-Making During Drug Development: A Qualitative Study, Value in Health, 2017:20(9); A540-A540


Therapeutic area: Rheumatiod arthritis

Study led by: Uppsala University

PREFER lead team: Karin Schölin-Bywall, Ulrik Kihlbom, Jorien Veldwijk

MPLC decision point of interest: Marketing authorisation and post-marketing

PREFER case study acronym: N/A

Clinical objectives: To elicit RA patients’ preferences, To estimate Minimum Acceptable Benefit, To explain preference heterogeneity

Patients from: Sweden

Methods in Qualitative study: Focus groups, Nominal group technique

Methods in Quantitative study: Discrete Choice Experiment (DCE)

End-date qualitative data collection: March 2019

End-date quantitative data collection: November 2019






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The Patient Preferences in Benefit-Risk Assessments during the Drug Life Cycle (PREFER) project has received funding from the Innovative Medicines Initiative 2 Joint Undertaking under grant agreement No 115966. This Joint Undertaking receives support from the European Union's Horizon 2020 research and innovation programme and the European Federation of Pharmaceutical Industries and Associations (EFPIA).