Background/Purpose: Negative Illness perceptions (IPs) are associated with poorer disease outcomes in  rheumatoid arthritis (RA). Unfortunately, IPs are generally fixed in established RA. We hypothesized that IPs are modifiable in arthralgia at-risk of RA. We aimed to study if the prospect of treatment, or receiving DMARD-treatment itself, will lead to more positive IPs in patients with clinically suspect arthralgia (CSA).

Methods: 485 CSA-patients were studied for IPs at baseline using the Brief Illness Perception Questionnaire (BIPQ), covering cognitive, emotional and comprehensibility domains. Of these, 249 (included in observational cohorts) were informed that there is no DMARD-treatment, while 236 were offered DMARD-treatment in the TREAT-EARLIER trial.  Furthermore the effect of receiving DMARD-treatment itself on IPs was studied by comparing the course of BIPQs during two-year of patients receiving treatment (1-year methotrexate) or placebo in the TREAT-EARLIER trial.

Results: Comparison at baseline showed that CSA-patients to whom treatment was offered have more confidence in treatment (p=0.002) and experience a deeper understanding of their disease (p=0.002). Longitudinal comparisons showed that patients who received treatment show sustained improvements in IPs compared to placebo in four cognitive domains: the experience of physical complaints (p=0.040), the illness’ influence on their life (p=0.001), the treatment effectiveness (p=0.041) and longevity of the disease (p=0.045).

Conclusion: Both the prospect of treatment and DMARD-treatment itself improved IPs in CSA, mainly in cognitive domains. These data suggest the presence of a ‘psychological window-of-opportunity’, which may provide possibilities to improve disease outcomes.

ACR Meeting Abstracts - https://acrabstracts.org/abstract/can-treatment-expectations-or-treatment-itself-in-patients-with-arthralgia-suspicious-for-progression-to-rheumatoid-arthritis-improve-illness-perceptions/