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.

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.