RESEARCH ARTICLE Open Access Perceptions of first-degree relatives of patients with rheumatoid arthritis about lifestyle modifications and pharmacological interventions to reduce the risk of rheumatoid arthritis development: a qualitative interview study Gwenda Simons 1*† , Rebecca J Stack 1,2† , Michaela Stoffer-Marx 3,4 , Matthias Englbrecht 5 , Erika Mosor 3,6 , Christopher D Buckley 1,7,8 , Kanta Kumar 9,10 , Mats Hansson 11 , Axel Hueber 5 , Tanja Stamm 3,6 , Marie Falahee 1 and Karim Raza 1,7,8 Abstract Background: There is increasing interest in the identification of people at risk of rheumatoid arthritis (RA) to monitor the emergence of early symptoms (and thus allow early therapy), offer lifestyle advice to reduce the impact of environmental risk factors and potentially offer preventive pharmacological treatment for those at high risk. Close biological relatives of people with RA are at an increased risk of developing RA and are therefore potential candidates for research studies, screening initiatives and preventive interventions. To ensure the success of approaches of this kind, a greater understanding of the perceptions of this group relating to preventive measures is needed. Methods: Twenty-four first-degree relatives of patients with an existing diagnosis of RA from the UK, three from Germany and seven from Austria (age: 21–67 years) took part in semi-structured interviews exploring their perceptions of RA risk, preventive medicine and lifestyle changes to reduce RA risk. Interviews were audio-recorded, transcribed verbatim and analysed using thematic analysis. Results: Many first-degree relatives indicated that they anticipated being happy to make lifestyle changes such as losing weight or changing their diet to modify their risk of developing RA. Participants further indicated that in order to make any lifestyle changes it would be useful to know their personal risk of developing RA. Others implied they would not contemplate making lifestyle changes, including stopping smoking, unless this would significantly reduce or eliminate their risk of developing RA. Many first-degree relatives had more negative perceptions about taking preventive medication to reduce their risk of RA, and listed concerns about potential side effects as one of the reasons for not wanting to take preventive medicines. Others would be more willing to consider drug interventions although some indicated that they would wish to wait until symptoms developed. (Continued on next page) * Correspondence: g.simons@bham.ac.uk † Gwenda Simons and Rebecca J Stack contributed equally to this work. 1 Institute for Inflammation and Aging, Rheumatology Research Group, College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, UK Full list of author information is available at the end of the article BMC Rheumatology © The Author(s). 2018 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Simons et al. BMC Rheumatology (2018) 2:31 https://doi.org/10.1186/s41927-018-0038-3