Background/Purpose: A preclinical phase of rheumatoid arthritis (RA), in which ‘at-risk’ individuals develop autoantibodies and/or symptoms and progress to clinical arthritis and classifiable RA, is well established (1). Emerging evidence suggests intervention in the pre-arthritis phase could reduce the risk of RA developing, delay onset and progression of RA, or reduce the severity of the condition should it develop (2). Preventive interventions include drug therapies and lifestyle changes. It is important that potential treatments are acceptable to at-risk individuals, particularly as RA prevention trials to date have demonstrated recruitment challenges (2). This study aimed to explore factors that would influence at-risk individuals’ engagement with potential preventive interventions, including RA medication, antibiotics, probiotics, oral health treatment and maintenance, dietary changes, and smoking cessation.

Methods: This was a qualitative study employing a phenomenological approach. Anti-cyclic citrullinated peptide (anti-CCP) positive at-risk individuals with musculoskeletal symptoms but no synovitis were recruited from the Leeds CCP cohort. Individual semi-structured interviews were conducted via video or telephone between March-June 2022. Interviews were audio-recorded and transcribed verbatim and data were analyzed using reflexive thematic analysis. A secondary ideal-type analysis was subsequently conducted to understand different approaches to health-related behaviors.

Results: Nineteen CCP+ at-risk individuals (ten women; age range 35-70) participated. Three overarching themes were identified (Figure 1). Participants described distress related to ongoing symptoms and a burden of uncertainty regarding disease progression. Many participants had concerns about side effects of preventive RA medication and preventive antibiotics. In contrast, most participants expressed willingness to take a probiotic, and to make oral health and dietary changes with the aim of preventing RA. Participants’ perceived engagement with preventive measures was influenced by symptom severity, personal risk level, comorbidities, experiences of taking other medications or supplements, knowledge of risk factors, and perceived effort. Three ‘types’ of participants were identified from the data: pro-active preventers (health-conscious, seek information and act on knowledge about being at-risk); change considerers (deal with health issues as they happen, rely on direct medical advice to make changes); fearful avoiders (worry about the future, limited engagement).

Conclusion: Our study suggests that having more severe symptoms, a higher personal risk level, increased knowledge about risk factors, and positive experiences of taking other medications would increase engagement with preventive interventions among CCP+ at-risk individuals, but that an individual’s overall orientation to health behaviors also impacts on their attitude towards preventing RA. These findings could inform recruitment and retention in pre-RA research and promote uptake of preventive interventions in clinical practice.

References
1. MankiaK. Arthritis Rheumatol 2016.
2. Falahee M. Front Immunol. 2022.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/what-is-my-risk-really-a-qualitative-exploration-and-ideal-type-analysis-of-preventive-interventions-among-individuals-at-risk-of-rheumatoid-arthritis/