Background Preference for the status quo, or clinical inertia, is a barrier towards implementing treat-to-target protocols in patients with chronic diseases such as rheumatoid arthritis (RA). The objectives of this study were to examine the influence of subjective numeracy on RA-patient preference for the status quo and to determine whether age modifies this relationship. Methods RA patients participated in a single face-to-face interview. Numeracy was measured using the Subjective Numeracy Scale. Treatment preference was measured using Adaptive Conjoint Analysis. Results Of 205 eligible subjects, 156 agreed to participate. Higher subjective numeracy was associated with lower preference for the status quo in a regression model including race, employment, and biologic use [Adjusted OR (95% CI)= 0.71 (0.52–0.95), p= 0.02]. Higher subjective numeracy was protective against status quo preferences among subjects less than 65 years of age [Adjusted OR (95% CI)= 0.64 (0.43–0.94), p= 0.02], but not among older subjects. Conclusions In summary, subjective numeracy is independently associated with younger, but not older, RA patients’ preferences for the status quo. Our results add to the literature demonstrating age and numeracy differences in treatment preferences and medical-decision-making processes.

Background Rheumatoid arthritis (RA) treatment regimens are not adjusted in response to active disease as frequently as indicated. The objective of this study was to examine how disease activity and patients’ illness beliefs combine to predict future treatment changes in patients who are currently under the care of a rheumatologist. Methods We interviewed RA patients at baseline, 2, 4 and 6 months. We examined the association of disease activity (RAPID-4) and five specific illness beliefs (consequences, treatment control, symptom burden, concern, emotional impact) with future escalation of treatment using logistic regression. Analyses were adjusted for age, current biologic use, and disease duration. Disease activity and illness beliefs were dichotomized at the median to create four dummy variables (e.g. Low disease activity + High illness belief) in order to examine the combined impact of disease activity and illness beliefs on escalation. Results Twenty-nine percent of the participants (N=142) had an escalation of treatment during the follow-up period. When examined separately, disease activity and four of the illness beliefs (consequences, symptom burden, concern, and emotional impact) were associated with future escalation. High disease activity was predictive of future escalation only when combined with high levels of consequences, concern, and emotional impact. The combinations of high disease activity and high consequences, concern, and emotional impact were much stronger predictors or future escalation than either factor in isolation. Conclusions The findings suggest that patients’ illness beliefs are an important determinant of treatment decisions which are not fully captured by disease activity measures alone.

The conceptual model indicates that patients approach the decision to escalate care differently from physicians. In order to improve care in RA, it is important to recognize that many patients with moderate to high disease activity are not open to alternative treatments, which is a prerequisite to engaging in decision making. Routine clinical encounters should enable health care providers to identify these patients in order to tailor education prior to recommending treatment escalation.