There have been numerous studies done over the last 5 years that have shown there is a core set of domains favored by healthcare providers. These include pain and function, tender and swollen joint counts, patient and physician global assessments, and laboratory values. While many individuals share these goals in a general sense, there is a parallel desire of many patients to include several other treatment goals, such as fatigue reduction, disease self-management, the emotional stress of RA, poor sleep quality, and lack of vitality. These patient goals are not always in alignment with established medical goals, and that results in gaps that often fall under the general heading of ”goals in wellness.” Rheumatologists have an opportunity to close these gaps and place a greater emphasis on our patients’ goals of treatment, such as exercise, sound nutrition, sleep hygiene, and stress reduction. 

So, what keeps rheumatologists from heavily engaging in these types of measures? I think part of the problem is that most of us recognize there is no “secret sauce” for wellness. Yet, learning theory supports the notion that, if patients can become empowered and recognize these behaviors as directly affecting their disease and its manifestations and complications, they are much more likely to engage in wellness-like behavior. Patients need to understand that these behaviors are linked to their immune system and that their personal behaviors can actually modify these interactions and have an ameliorative effect on their disease. We have known this for decades. 

With respect to wellness goals, the opportunities for patient education are many. Consider the patient with RA who has a significantly elevated body mass index. One might deem responsibilities in this area as falling squarely on the shoulders of the primary care physician; however, pathologic adiposity is clearly relevant in rheumatology. Similarly, stress reduction works against the magnification of fatigue and pain, and improving sleep quality and implementing good sleep hygiene can also be ameliorative in RA. These are all domains that may not traditionally fall solidly in the province of rheumatology but can have tremendous impact on the patient with RA, and therefore it may be of value to emphasize these points in our discussions with patients.

Another opportunity for patient education, I believe, is the proper framing of the risks and benefits of treatment. For instance, Jack Cush, MD, from Baylor University Medical Center, points out that he will often communicate to patients that their disease, if left untreated, is riskier than the potential side effects of the drugs that they would be taking to treat their disease. The side effects of untreated RA are much more severe than the potential side effects of the drugs that are available to treat the disease. And patients may not have thought in those terms before because they may not equate a lack of treatment with the potential of an adverse effect of a drug.