Online Rheumatoid Arthritis Support Tool Can Aid Treatment Decisions

Among those deciding to escalate care, 32% in the intervention group met the criteria for making an informed decision compared with 13% in the control group.

An interactive, online support tool can assist patients with rheumatoid arthritis in making the decision to escalate care with biologic agents, according to research published in Arthritis Care & Research.

Despite that a treat-to-target approach has been shown to improve both short-term and long-term outcomes in rheumatoid arthritis and that physicians are advised to monitor and escalate treatment to reach remission or lower disease activity, many patients are not effectively treated with disease-modifying antirheumatic drugs (DMARDs).

Because previous research suggests this may in part be due to inadequate decision-making support as patients consider whether or not to escalate treatment, Liana Fraenkel, MD, MPH, from the Yale University School of Medicine and colleagues conducted a study to see whether support provided in the form of an online interactive tool would help patients make an informed decision regarding their treatment.

The researchers randomly assigned 125 participants with rheumatoid arthritis to either receive a link to an online tool (the intervention group) or to standard care (control). Standard care included education and counseling by an experienced nurse educator about the risks and benefits of biologic agents and how to administer injections (when appropriate).

At 2-week follow-up, significant improvements were seen in the intervention group in objective knowledge, subjective knowledge, values clarification, and satisfaction with risk communication. Among those deciding to escalate care, a greater percentage in the intervention group met the criteria for making an informed decision compared with the control group (32% vs 13%, P = .02).

At 8 weeks, improvements in subjective knowledge and values clarification persisted, but there were no differences in objective knowledge between the groups.

“The importance of this finding is unclear given that informed choice is most important at the moment of choice and memory for objective knowledge is always likely to fade,” wrote Dr Fraenkel and colleagues.

The researchers note that they measured both objective knowledge and subjective knowledge (the “feeling of knowing”) because both types of knowledge play distinct roles in decision-making. This study as well as past studies suggest that education is most effective when both objective and subjective knowledge are improved.

“Future efforts will be required to ensure that the information is updated as needed and that the tool is easily accessible, ideally via a link through trusted websites already familiar to rheumatologists,” the authors conclude.


Fraenkel L, Matzko CK, Webb DE, et al. Use of decision support for improved knowledge, values clarification, and informed choice in patients with rheumatoid arthritis.Arthritis Care Res. 2015; doi:10.1002/acr.22659.