Grant: Operating Grant

Rheumatoid arthritis (RA) is a chronic condition in which the immune system attacks the joints, resulting in joint swelling, pain, and difficulty moving. There is no cure for people living with RA, but fortunately many treatment options are available. Starting effective treatment early is important, as inflammation that is not treated can cause permanent joint damage. Choosing the right treatment can be difficult because treatments differ in their risks and benefits. Currently, most patients who see a rheumatologist will take methotrexate, as we know it works well and is generally well tolerated. Recent studies, however, suggest that a combination of three different medications (methotrexate, sulphasalazine and hydroxychloroquine), commonly known as 'triple therapy' is more effective than methotrexate alone. However, triple therapy may have a higher chance of certain side effects and requires taking many pills. The choice of treatment therefore needs to consider preferences of informed patients. The goal of this project is to better understand why this more effective treatment is not commonly used. First, we will survey both patients and rheumatologists to determine what is important to them when choosing between these treatments. Second, we will determine physicians' views about how effective and safe triple therapy is. Finally, we will combine patients' preferences with research evidence in a mathematical model to determine which treatment patients would prefer. We will compare this to a model that uses physicians' preferences instead of patients, or physicians' views about how good and safe triple therapy is, based on their experience. Through these different models we will determine how we can inform treatment strategies in early RA to match best evidence and patients' preferences.