medwireNews: Results of a proof-of-concept trial suggest that providing personalized information about rheumatoid arthritis (RA) risk using an online tool could motivate people to improve their health behaviors.
Behavioral factors – including smoking, obesity, poor dental health, and low fish intake – “are associated with increased RA risk,” and could be “the only potentially modifiable risk factors” for the disease, say Jeffrey Sparks (Brigham and Women’s Hospital, Boston, Massachusetts, USA) and study co-authors.
The study involved relatives of RA patients, specifically 238 first-degree relatives who were free from RA themselves at baseline. Participants were randomly assigned to receive information on their RA risk via the Personalized Risk Estimator for RA (PRE-RA) tool – a web-based educational intervention taking into account personalized genetic, demographic, biomarker, and behavioral information – either with or without a one-to-one session to facilitate interpretation, or to receive standard education on RA through handouts and a presentation.
Readiness to change RA-related risk behaviors, defined as an increase in validated contemplation ladder scales, was measured immediately after the intervention, and then at a 6-week and a 6-month follow-up visit.
In all, 63.9% of 158 participants who received the PRE-RA intervention had improvements in readiness to change their risk behaviors at the 6-month follow-up, compared with 50.0% of 80 participants in the control group, giving a significant age-adjusted difference of 15.8%.
When results from the three timepoints were combined, subjects given the personalized risk information were a significant 23% more likely to increase their motivation to improve health behaviors than those given standard education. There was no significant difference in willingness to change health behaviors among participants who received the PRE-RA intervention alone versus in combination with the one-to-one health education session.
In an analysis of self-reported behavioral changes, the researchers found that participants in the PRE-RA group were significantly more likely to report increasing their fish intake (45.0 vs 22.1%), as well as brushing (40.7 vs 22.9%) and flossing (55.7 vs 34.8%) their teeth more frequently at 6 months after the intervention than those in the comparison group.
A substantial proportion of subjects in both groups reported increasing their levels of physical activity over the study period (50.4 vs 46.5%), and 62.5% of 8 subjects in the PRE-RA group who smoked at baseline reported quitting by month 6, compared with none of the three smokers in the control group.
These results suggest that “web-based personalized medicine approaches may be useful to motivate health behavior improvements to potentially lower RA or other chronic disease risk,” write the researchers in Arthritis Care & Research.
They caution, however, that “[t]here is currently no evidence that increasing physical activity, improving dental hygiene, or increasing fish intake reduces RA risk, despite other known health benefits of these behaviors,” and that the findings “may only be applicable to [first-degree relatives] of patients with RA but not to other chronic rheumatic diseases.”
Nevertheless, the team concludes that “encouraging behavior change is the first step towards establishing rationale for larger behavior intervention trials powered to investigate the effect of behavior change on RA risk or surrogate biologic markers, such as RA-related autoantibody development.”
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