Rheumatoid arthritis (RA) is the most common auto-immune arthritis with a prevalence between 0.5 - 2.5%. It is associated with substantial morbidity, mortality, and cost. Disease modifying anti-rheumatic drugs (DMARDs) reduce inflammation through a variety of mechanisms, improving short and long-term outcomes in RA. While there are a variety of drug-related toxicities, DMARDs are now accepted as standard of care for the medical management of RA, being recommended by the National Committee on Quality Assurance, the American College of Rheumatology (ACR), and the European League Against Rheumatism. Despite the recognized benefits of DMARDs, several published studies from the US, Canada, and Europe have found that 25-50% of patients diagnosed with RA do not use DMARDs, indicating sub-optimal care. There seem to be two major factors driving DMARD non-use: lack of access to expert rheumatic disease care and patient preferences. Access to rheumatologists is an acknowledged problem based on a report of the ACR finding that the aging US population will contribute to a 50% shortage of rheumatologists by 2025. It is very unlikely that rheumatology training programs can make up the deficit, suggesting that primary care providers (PCPs) will need to increase their familiarity with managing rheumatologic conditions, including RA. This trend coincides with the current push for primary care redesign, allowing for more comprehensive and collaborative management of diseases sometimes managed by specialists. An improved system for co-management between PCPs and rheumatologists around diseases like RA is needed.
The first aim of this project, a 2x2 factorial randomized controlled trial, will test two different interventions. One will attempt to forge new collaborative care relationships between PCPs and rheumatologists, within the context of managing RA. The second will focus on patients and their preferences regarding RA treatment. Like other medications, patients express concerns about DMARD toxicities and how to balance risks and benefits. Addressing such issues appears to improve treatment compliance in other conditions and may help reduce DMARD non-use. We will attempt to address these issues through a telephonic health education program.
The second aim will examine the economic implications of the intervention. We will use simulation models to calculate the long-term implications of the interventions tested in the aim one.

Public Health Relevance

This work is relevant because of the prevalence of RA, its associated morbidity and mortality, and the need to improve collaborative care. The lessons learned in the proposed research will inform system redesign in rheumatology as well as across the health care system.

National Institute of Health (NIH)
National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
Comprehensive Center (P60)
Project #
Application #
Study Section
Special Emphasis Panel (ZAR1-KM)
Project Start
Project End
Budget Start
Budget End
Support Year
Fiscal Year
Total Cost
Indirect Cost
Brigham and Women's Hospital
United States
Zip Code
Ananthakrishnan, Ashwin N; Cagan, Andrew; Cai, Tianxi et al. (2016) Identification of Nonresponse to Treatment Using Narrative Data in an Electronic Health Record Inflammatory Bowel Disease Cohort. Inflamm Bowel Dis 22:151-8
Sparks, Jeffrey A; Karlson, Elizabeth W (2016) The Roles of Cigarette Smoking and the Lung in the Transitions Between Phases of Preclinical Rheumatoid Arthritis. Curr Rheumatol Rep 18:15
Kim, Seoyoung C; Kim, Dae Hyun; Mogun, Helen et al. (2016) Impact of the U.S. Food and Drug Administration's Safety-Related Announcements on the Use of Bisphosphonates After Hip Fracture. J Bone Miner Res 31:1536-40
Sparks, Jeffrey A; Chang, Shun-Chiao; Deane, Kevin D et al. (2016) Associations of Smoking and Age With Inflammatory Joint Signs Among Unaffected First-Degree Relatives of Rheumatoid Arthritis Patients: Results From Studies of the Etiology of Rheumatoid Arthritis. Arthritis Rheumatol 68:1828-38
Suter, Lisa G; Smith, Savannah R; Katz, Jeffrey N et al. (2016) Projecting Lifetime Risk of Symptomatic Knee Osteoarthritis and Total Knee Replacement in Individuals Sustaining a Complete Anterior Cruciate Ligament Tear in Early Adulthood. Arthritis Care Res (Hoboken) :
Solomon, Daniel H; Lee, Sara B; Zak, Agnes et al. (2016) Implementation of treat-to-target in rheumatoid arthritis through a Learning Collaborative: Rationale and design of the TRACTION trial. Semin Arthritis Rheum 46:81-7
Deshpande, Bhushan R; Losina, Elena; Smith, Savannah R et al. (2016) Association of MRI findings and expert diagnosis of symptomatic meniscal tear among middle-aged and older adults with knee pain. BMC Musculoskelet Disord 17:154
Ananthakrishnan, Ashwin N; Cagan, Andrew; Cai, Tianxi et al. (2016) Statin Use Is Associated With Reduced Risk of Colorectal Cancer in Patients With Inflammatory Bowel Diseases. Clin Gastroenterol Hepatol 14:973-9
Katz, Jeffrey N; Smith, Savannah R; Yang, Heidi Y et al. (2016) The Value of History, Physical Examination, and Radiographic Findings in the Diagnosis of Symptomatic Meniscal Tear among Middle-Age Subjects with Knee Pain. Arthritis Care Res (Hoboken) :
Sparks, Jeffrey A; Chang, Shun-Chiao; Karlson, Elizabeth W (2016) Authors' reply to the letter ""Mortality due to respiratory causes in rheumatoid arthritis should be interpreted in the context of 'ever' smoking and may be due to ILD"". Arthritis Care Res (Hoboken) :

Showing the most recent 10 out of 404 publications