At-Risk RA Individuals Have Different Views on Preventive Measures

A new study identified 3 types of at-risk rheumatoid arthritis (RA) individuals based on their perspectives on taking preventative measures to curb or stop the development of RA.¹ The types were characterized as “proactive preventers, change considerers, and fearful avoiders.”

“Our study is the first to explore the perceptions of at-risk individuals of measures aiming to address the gut microbial dysbiosis implicated in development of RA,” wrote investigators, led by Laura S. Chapman, from Leeds Institute of Rheumatic and Musculoskeletal Medicine at the University of Leeds in the United Kingdom.

According to the Arthritis Foundation, many risk factors can increase someone’s chances of developing RA.² The organization lists some uncontrollable risk factors, such as age, biological sex, and genes—particularly, the genetic marker, the shared epitope.

Environmental factors can increase the risk, such as infections like Epstein-Barr virus, E. coli, and hepatitis C; toxins including second-hand smoke, asbestos, silica dust, and pesticides; and childhood trauma. Lifestyle factors can also increase the risk, such as smoking, obesity, gum disease, food, and changes in the microbiome.

Interventions before arthritis can have a large impact—potentially preventing the onset of the disease, or at least, delaying it or reducing the disease severity.¹ Although having an intervention may sound like a clear choice to some, other people may be hesitant to have an intervention. They might think: what is the point of taking preventive measures if I barely have symptoms?

However, not only can preventative interventions regulate the immune response, but they can also target other risk factors such as smoking, elevated body mass index (BMI), and dyslipidemia. Preventive measures can be anything from taking medication to lifestyle changes including a healthy diet, more exercise, and quitting smoking.

The study sought to explore perspectives of individuals at risk of developing RA, hoping to learn what they thought about their RA risk, as well as their opinions on preventive interventions. As a secondary endpoint, investigators also aimed to understand and compare various health-related behaviors regarding RA prevention.

The study included 19 anti-CCP-positive individuals aged 35 – 70 years with musculoskeletal symptoms but no synovitis who participated in semi-structured interviews. More than half of the participants were women (n = 10).

Investigators spotted 3 themes: being at risk for anti-CCP-positive, wanting to prevent RA, and “influencers of engagement.”

Although some participants talked about distress regarding symptoms, feeling uncertain about the disease progression, and the adverse events of the medication, many participants had a positive opinion of the intervention and were willing to adopt lifestyle habits to prevent RA.

Certain factors influenced the willingness to engage with preventive interventions, including symptom severity, personal risk level, co-morbidities, and experiences of taking other medications or supplements. Furthermore, people were more likely to engage with preventive measures if they had knowledge of RA, risk factors, and medications.

Ultimately, 3 types of participants were identified from the study: proactive preventers (n = 8), change considerers (n = 9)—this type of individual would be more likely to be swayed if a doctor advised them to make lifestyle changes or go on medication—and fearful avoiders (n = 2). People who had healthier lifestyles were more likely to have a more positive attitude toward preventing RA.

People were also more likely to take preventive measures if they heard how painful RA could be. One participant said, “It can progress at absolutely any time, it could be tomorrow that it could progress, or it could be 10 years, or it could be 5 … I don’t know. Is it … volatile, ’cause you can’t predict it, and if it does hit, when it hits, it’s gonna be life changing? That to me makes it a much riskier condition to sort of ignore.”

Proactive preventers tended to understand that an increased CCP in the blood means they have a greater risk of developing RA and would seek more knowledge on their risk. Change considers knew less about what being at risk meant and tended to not seek out information on their risk on their own.

In contrast, fear avoiders often did not have much knowledge about their risk of RA and did not engage in heathy lifestyles, which could explain why they were not willing to take preventative measures. Fear avoiders said they would be more likely to have a treatment to prevent RA if they had worse symptoms—or if their risk for developing RA was high—thus needing more of a justification. People were also hesitant to take preventive measures with medication if they experienced negative adverse events from other medications.

Investigators highlighted multiple limitations, including the small sample size, did not explicitly explore typology during data collection despite ideal-type analysis, questions asked were geared toward oral health, and participants were recruited from a previous research cohort making them more likely to be proactive preventers.

“Understanding specific barriers and facilitators to the different ideal types of patients will be beneficial to increase engagement with preventive interventions in individuals at risk and will help clinicians to recruit and maintain patient participation in preventive intervention studies,” investigators concluded.

^References

1. ^{Chapman LS, Siddle HJ, Serban S, et al. 'What is my risk really?': a qualitative exploration of preventive interventions among individuals at risk of rheumatoid arthritis. Rheumatol Adv Pract. 2024;8(2):rkae023. Published 2024 Feb 29. doi:10.1093/rap/rkae023}
2. ^{11 Risk Factors for Rheumatoid Arthritis and What You Can Do about Them. Arthritis Foundation. December 14, 2022. https://www.arthritis.org/health-wellness/about-arthritis/understanding-arthritis/11-risk-factors-rheumatoid-arthritis-reduce-risk. Accessed March 22, 2024.}