Patient Rheumatoid Arthritis Social Support Study

Rheumatoid arthritis (RA) is a chronic disabling disease that affects nearly 1% of the U. S.
population [1]. The illness causes destruction of joint cartilage and erosion of adjacent
bone, leading to joint replacement as well as extra-articular disease including
cardiopulmonary manifestations, vasculitis, gastrointestinal and infectious complications
[2]. Many patients with RA over time suffer progressive disability [3, 4], pain [5], work
loss [3, 6], substantial health care costs [7], and premature mortality [8]. The current
treatment of RA results in only modest improvements in functional status and many patients
progress to chronic disability. Treatment is focused on ameliorating symptoms and halting
disease progression as early as possible to prevent joint damage and functional decline.

Research has shown that while patient response to different medications may vary, those with
chronic illness universally require social support and human empathy to achieve the best
physical and emotional outcomes. From the 2006 PACO focus groups, we learned that RA
patients' greatest concern was social isolation, that almost all had never talked with
another person with RA, and that they feel alone dealing with the challenges of the disease.
Psychosocial support is a seminal aspect of disease management since interpersonal
relationships are often affected by the fatigue and physical disability of the disease and
self-efficacy by the resulting loss of independence. The purpose of this study is to further
patient care by providing social support services to better arthritis outcomes and patient
satisfaction. In this pilot initiative called PARASS Patient-to-Patient Connection, patients
will be able to connect with fellow patients who have similar concerns and fears and can find
empathy and understanding based on personal experience. Buddy systems matching patients with
similar needs or interests have been successful in addiction rehabilitation and oncology
treatment, and group sessions have long been used as teaching and support tools in diabetes
management. Rheumatology, however, has to date focused largely on providing patients with
tools to improve the more physical manifestations of pain, swelling and fatigue. Furthermore,
efforts to enhance self efficacy through leader initiated self help courses have not produced
expected improvements in clinical outcomes. The purpose of this initiative is to develop a
novel method of patient empowerment using peer support in order to better arthritis outcomes
and patient satisfaction. To our knowledge, no rheumatology clinics in the United States have
developed or instituted organized programs for peer social support or group informational
discussion.

The goal of PARASS is to develop a network of increased social support for Rheumatoid
Arthritis (RA) patients that will improve patient outcomes and further promote understanding
of RA among physicians and patients in the clinic community. This will be accomplished with
the development and implementation of a "buddy pairing" program called Patient-to-Patient
Connection.

Inclusion Criteria:

- billing diagnosis of rheumatoid arthritis (714.0) or seronegative inflammatory
arthritis or a member of the BRASS and PACO studies at Brigham and Women's Hospital

Exclusion Criteria:

- less than 18 years of age