Communication of biomarker, genetic, lifestyle risk factor profiles for RA

在诊断类风湿性关节炎（RA）之前多年，血清中自身抗体和细胞因子的鉴定表明在临床前阶段预防疾病的机会。最近的研究已经认识到，RA发生在暴露于环境因素（包括吸烟、牙周炎和饮食因素）后具有遗传风险因素的个体中。与一般人群相比，一级亲属（FDR）患RA的风险增加3至9倍。尽管对RA发展中的个体风险因素的了解不断扩大，但还没有研究如何最好地传达特定个体的生物标志物，遗传和生活方式风险特征，以实现RA的个性化预防。鉴于最近出现的有效的早期治疗和预防性治疗的承诺，RA风险预测现在有可能避免风险患者数十年的残疾。在这个项目中，我们将建立在我们先前的发现和风险模型的基础上，开发一个结合生物标志物，遗传和生活方式因素的在线RA风险计算器。然后，我们将使用该风险计算器在RA患者的一级亲属中进行随机对照试验，以测试风险教育和咨询对采取预防性健康行为的准备程度的影响。我们提出以下具体目标：1）开发一个在线RA风险计算器，一个个性化的沟通工具，包括生物标志物，遗传和生活方式RA风险因素和2）进行一项随机试验，向RA患者的一级亲属传达风险因素概况，以测试使用风险预测概况和教育是否会导致准备采取行为以降低RA风险的变化和健康行为的改变。我们将进行一项3组随机试验，分配222名FDR接受：（i）印刷小册子，（ii）在线风险沟通或（iii）在线风险沟通加上健康教育和咨询。我们将在干预后6周、6个月和12个月对这些组进行随访，以确定改变吸烟、口腔健康或饮食行为的行为准备变化以及健康行为变化。

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.