'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 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 to identify factors influencing their engagement with prevention. A secondary aim, established during the analytical process, was to understand and compare different approaches to health-related behaviours related to prevention of RA.Methods Anti-CCP-positive (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 (10 women; age range 35-70 years) participated. Three overarching themes were identified: being CCP+ at risk; aiming to prevent RA; and 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, co-morbidities, 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 the attitude towards preventing RA.Conclusion Findings could inform recruitment and retention in RA prevention research and promote uptake of preventive interventions in clinical practice. What does this mean for patients?Some people are at higher risk of developing rheumatoid arthritis (RA). They develop markers in their blood and can experience symptoms before being diagnosed with RA. Having treatment might prevent or delay development of RA. However, treatments need to be acceptable to people at risk of developing RA. We interviewed 19 people at risk of developing RA to explore their perspectives of treatments aiming to prevent RA. We asked about taking medications and making lifestyle changes. Similar to previous research, people at risk of developing RA told us that treatments aiming to prevent it would be more acceptable if their symptoms were worse and their personal risk of developing RA was high. We also found that medications aiming to prevent RA were less acceptable to people who had experienced negative side effects from any other medications in the past. Additionally, there were distinct attitudes towards prevention of RA. Some people were proactive, some relied on direct medical advice to make changes, and others wanted to avoid thinking about RA entirely. Our findings could help more people at risk of RA to take part in research to determine whether medication and/or making lifestyle changes aiming to prevent the development of RA is effective.