Table 3.

Challenges and opportunities for behavioral modifications among rheumatoid arthritis risk groups.

At-Risk Group	Challenges	Opportunities
General population	Low general understanding or motivation related to RA Potential unwillingness to change behaviors Low absolute risk for RA	Education about RA, risk factors, early symptoms, and prevention strategies Targeted behavioral interventions Public health initiatives for other reasons may impact RA risk (legislations against smoking, legislation to promote healthy eating, etc.)
Genetic risk (e.g., HLA-DRB1 shared epitope)	Unclear cost-benefit of testing for genetics Interpretation of direct-to-consumer genetic testing Risk of anxiety about genetic results	Education about genetic risks Personalized risk assessments Increased genetic testing and precautions when delivering genetic results
Family history (FDR without RA)	Perceptions of RA decrease likelihood of seeking predictive help Lack of information when making decisions about risk Potential unwillingness to make and sustain lifestyle changes Concerns about accuracy of predictive testing Concerns about anxiety of predictive test	Education about risk factors, early symptoms, and prevention strategies Personalized risk assessments Increased genetic testing and precautions when delivering genetic results
Biomarker risk (CCP+, RF, anti-CarP, anti-PAD3)	Lack of understanding of RA risk Need more information on RA and risk Anxiety about test results	Improve self-efficacy and health literacy Build on existing willingness to make lifestyle changes Build on expressed interest in gaining information, assurance, confirmation of meaning of clinical test
Clinical pre-RA risk (e.g., palindromic rheumatism, arthralgias, undifferentiated IA)	Some do not view themselves as patients or already feel they have RA Difficulty in understanding statistical risk of progression to RA Fear of pain, uncertainty of pain progression, developing functional limitations and prognosis	Education about early symptoms and risks Personalized risk assessments Present information in a way that makes sense to patients Learning risk group made risk groups more likely to adopt healthier habits changes, haptonomy, yoga and mindfulness.

RA, rheumatoid arthritis, FDR, first-degree relative.