Background/Purpose

Having a first-degree relative (FDR) with RA increases personal RA risk by four-fold. Other RA risk factors include demographics, genetics, auto-antibodies, and behaviors. We aimed to develop a personalized RA risk tool incorporating these risk factors, suitable for use in RA education trials. We explored changes in self-perceived RA risk and RA knowledge after personalized RA risk education among a group at increased RA risk due to having a relative affected with RA.

Methods

We conducted a pilot study on RA self-perceived risk, knowledge, and attitudes among FDRs recruited at a large academic hospital. Eligible participants had a FDR with RA. We developed a web-based interactive tool, the Personalized Risk Estimator for RA (PRE-RA), which provided RA education and calculated lifetime RA risk based on demographics, genetics (HLA shared epitope), auto-antibodies (RF and ACPA), and behaviors (smoking, overweight/obesity, low fish intake, and dental health). RA knowledge and attitudes were assessed before and 6 weeks after the intervention: PRE-RA and health education. RA risk factor knowledge was evaluated by whether subjects agreed that an established risk factor, supported by literature, increased RA risk. An RA knowledge index was calculated by the total number of established factors agreed to increase RA risk. Self-perceived lifetime RA risk before and after the intervention was compared to the PRE-RAcalculated lifetime RA risk using Wilcoxon rank-sum test. RA knowledge and attitudes before and after intervention were compared by Fisher’s exact or Wilcoxon rank-sum tests.

Results

A total of 37 subjects enrolled in the study and 14 completed the PRE-RA tool with health education. Median age was 44 years (range 20-70) and 76% were female. Using demographics, behaviors, genetics, and auto-antibodies, the median personalized lifetime calculated RA risk was 5% (range 1-56, mean 12.4, SD 14.7; Table) and was significantly lower than self-perceived risk at baseline (median 50%, range 0-85, mean 38.6, SD 23.7; p=0.0002). After intervention, self-perceived risk approached the calculated PRE-RA risk but remained significantly higher (median 14%, range 1-80, mean 25.1, SD 26.5; p=0.04). RA knowledge index significantly improved after the PRE-RA tool (median 8, mean 8.6, SD 0.5) compared to baseline (median 6, mean 5.4, SD 1.6; p<0.0001). Only 20% agreed that smoking was a risk factor for RA at baseline, but 100% agreed after the intervention (p<0.0001).

Conclusion

We developed an interactive RA risk education tool, PRE-RA, personalized to demographics, behaviors, genetics, and auto-antibodies suitable for use in RA risk education trials. Subjects in our study had high self-perceived RA risk, compared to calculated risk, that became more accurate after personalized RA risk education. Knowledge of RA risk factors was low prior to intervention and significantly increased after the PRE-RA tool and health education.

Table. RA risk self-perception, knowledge, and attitudes at baseline and after the Personalized Risk Estimator for RA (PRE-RA) tool and health education among RA first-degree relatives.
Self-perceived vs. calculated lifetime RA risk
	Self-perceived lifetime RA risk (n = 37)	Calculated PRE-RA tool lifetime RA risk (n = 14)	P value
Baseline lifetime % RA risk, median (range)	50 (0-85)	5 (1-56)	0.0002
Post-intervention lifetime % RA risk, median (range)	14 (1-80)*	5 (1-56)	0.04
Baseline vs. 6-weeks after intervention
	Baseline (n = 37)	After PRE-RAtool and health education (n = 14)	P value
Lifetime % RA risk, median (range)	50 (0-85)	14 (1-80)	0.043
Smoking is a risk factor for RA, % agree	20%	100%	<0.0001
Diet is a risk factor for RA, % agree	53%	67%	0.68
Dental health is a risk factor for RA, % agree	7%	67%	0.003
Obesity is a risk factor for RA, % agree	40%	89%	0.033
RA knowledge index, median (range)	6 (3-8)	8 (7-9)	<0.0001
>45% lifetime RA risk for average person, % agree	16%	0%	0.17
18% lifetime risk of RA is low or very low, % agree	51%	36%	0.36
*A total of 14 subjects provided self-perceived risk after the PRE-RA tool and health education.

---

« Back to 2014 ACR/ARHP Annual Meeting

ACR Meeting Abstracts - https://acrabstracts.org/abstract/personalized-risk-education-for-rheumatoid-arthritis-improves-self-perceived-risk-accuracy-and-risk-factor-knowledge-in-first-degree-relatives/