The identification of autoantibodies and cytokines in the serum many years prior to the diagnosis of rheumatoid arthritis (RA) suggests opportunities to prevent disease during the pre-clinical phase. Recent research has led to the recognition that RA develops in individuals with genetic risk factors after exposure to environmental factors, including cigarette smoking, periodontitis, and dietary factors. Having a first degree relative (FDR) with RA increases RA risk 3- to 9-fold compared to that in the general population. Despite the expanding knowledge of individual risk factors in the development of RA, there have been no studies of how best to communicate biomarker, genetic and lifestyle risk profiles for a given individual to enable personalized prevention of RA. Given the recent emergence of effective early treatment and the promise of preventive therapies, RA risk prediction now has the potential to avert decades of disability in at-risk patients. In this project, we will build upon our prior discoveries and risk models to develop an online RA risk calculator that combines biomarker, genetic and lifestyle factors. We will then conduct a randomized, controlled trial using this risk calculator in aymptomatic first degree relatives of RA patients in order to test the impact of risk education and counseling upon the readiness to adopt preventive health behaviors. We propose the following specific aims: 1) To develop an online RA risk calculator, a personalized communication tool that includes biomarker, genetic and lifestyle RA risk factors and 2) To conduct a randomized trial of communication of risk factor profiles to first degree relatives of RA patients to test whether use of risk prediction profiles and education will result in change in readiness to undertake behaviors to decrease their RA risk and health behavior change. We will conduct a 3-arm randomized trial, assigning 222 FDRs to receive: (i) a printed pamphlet, (ii) online risk communication or (iii) online risk communication plus health education and counseling. We will follow these groups at 6 weeks, 6 months and 12 months post intervention in order to determine change in behavioral readiness to modify smoking, oral health, or diet behaviors and health behavior change.

Public Health Relevance

This innovative project will develop and validate an online risk calculator that includes biomarker, genetic and lifestyle risk profiles and test communication of personalized education about risk profiles for RA among asymptomatic first degree relatives of RA patients, a population at substantial risk for developing RA.

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