What motivates RA patients to increase care?

Research presented by investigators at WMR at the American College of Rheumatology National Scientific Meeting in Washington, DC.


The prescription of Disease Modifying Anti-rheumatic Drugs (DMARD) for patients with rheumatoid arthritis (RA) is considered a standard of effective care.

  • However only 63% of US Medicare managed care and 43% Canadian provincial RA patients take a DMARD.
  • The explanation for underutilization is not fully known.


A single center, randomized controlled factorial design cross-sectional mail survey of RA patients in a large regional-community rheumatology practice.

Patients were presented a hypothetical decision scenario where they were asked to consider switching DMARDs. They evaluated how risky the proposed medication was and how likely they would be to take it.


Of 1538 RA patients, 1009 or 71% completed the study.  Regression modeling evaluated predictors of risk perception and willingness to take the proposed medication.


  • Risk Perception was predicted by negative RA disease and treatment experience.
  • Willingness to take a proposed DMARD was predicted by current satisfaction with disease control.
  • Race and sex did not predict risk perception or DMARD willingness.
  • Depression did not predict risk perception or DMARD willingness.
  • Health literacy, independent of low education or demographics, was a common predictor of both risk perception and or DMARD willingness.

Main take home point:  

Cognitive bias, related to low health literacy, is a recognizable patient trait that may contribute to underutilization of DMARDs, and can potentially be accommodated with patient decision support

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