“What is my risk really?”: A qualitative exploration of preventive interventions among individuals at risk of rheumatoid arthritis

Objectives Intervention in the pre-arthritis phase of rheumatoid arthritis (RA) could prevent or delay the onset of disease. The primary aim of this study was to explore perspectives of being at-risk and potential preventive interventions among individuals at risk of developing RA, and identify factors influencing their engagement with prevention. A secondary aim, established during the analysis process, was to understand and compare different approaches to health-related behaviours related to preventing RA. Methods Anti-cyclic citrullinated peptide positive at-risk (CCP+ at-risk) individuals with musculoskeletal symptoms but no synovitis participated in semi-structured interviews. Data were analysed using reflexive thematic analysis, followed by a secondary ideal-type analysis. Results Nineteen CCP+ at-risk individuals (ten women; age range 35–70) participated. Three overarching themes were identified: i) being CCP+ at risk; ii) aiming to prevent RA; iii) influencers of engagement. Participants described distress related to symptoms and uncertainty about disease progression. Many participants had concerns about medication side effects. In contrast, most participants expressed willingness to make lifestyle changes with the aim of preventing RA. Engagement with preventive measures was influenced by symptom severity, personal risk level, comorbidities, experiences of taking other medications/supplements, knowledge of RA, risk factors and medications, and perceived effort. Three ‘types’ of participants were identified from the data: proactive preventers, change considerers, and fearful avoiders. Overall orientation to health behaviours also impacted on attitude towards preventing RA. Conclusion Findings could inform recruitment and retention in RA prevention research and promote uptake of preventive interventions in clinical practice

‘It surprised me a lot that there is a link’: a qualitative study of the acceptability of periodontal treatment for individuals at risk of rheumatoid arthritis

Objectives Current evidence suggests that periodontal disease could be a causal risk factor for rheumatoid arthritis (RA) onset and progression. Earlier periodontal intervention in individuals at risk of RA could provide a unique opportunity to prevent or delay the onset of RA. This study aimed to explore the acceptability of periodontal treatment as a measure to potentially prevent RA among at-risk individuals and healthcare professionals.Methods Semistructured interviews were conducted with anti-CCP positive at-risk individuals (CCP+ at risk) and a range of healthcare professionals. At-risk participant data were analysed using reflexive thematic analysis; subsequent coding of healthcare professional data was deductive, based on a preidentified set of constructs.Results Nineteen CCP+ at-risk and 11 healthcare professionals participated. Three themes (six subthemes) were identified: (1) understanding risk (knowledge of shared at-risk factors; information and communication); (2) oral health perceptions and experiences (personal challenges and opportunities for dental intervention and oral health maintenance; external barriers) and (3) oral health treatment and maintenance (making oral health changes with the aim of preventing RA; acceptability of participation in periodontal research).Conclusions Periodontal disease is common in individuals at risk of RA, but the impact of poor oral health may not be well understood. Oral health information should be tailored to the individual. CCP+ at-risk participants and healthcare professionals identified seeking dental treatment can be hindered by dental phobia, treatment costs or inability to access dentists. While CCP+ at-risk individuals may be reluctant to take preventive medications, a clinical trial involving preventive periodontal treatment is potentially acceptable