telephone script and invited them to participate in the study. Enrollment was stratified into three groups; 50 were required to have patient-provider discordance; 10 have patient-provider concordance and low disease activity (LDA); and 10 have patient-provider concordance and moderate-to-high disease activity (MHDA). There were no additional selection criteria. Two investigators abstracted the electronic health records of patients using a standardized case report form. Data from the most recent clinical rheumatology visit included demographic characteristics, provider type (i.e., physician, fellow, nurse practitioner, or physician assistant), patient and provider global VAS scores, tender and swollen joint counts of 0 to 28, use of synthetic or biologic disease-modifying antirheumatic drugs (DMARDs), and use of anxiolytics or antidepressants, fibromyalgia medications, opioid pain medications, or sleep aids. All prior records were reviewed and data were collected for joint erosions on plain radiographs of the hands and feet, serologic test results for rheumatoid factor (RF) and anticyclic citrullinated peptide (anti-CCP) antibodies, and associated physician-diagnosed comorbidities, including anxiety and depression, fibromyalgia, obstructive sleep apnea, and osteoarthritis. Disease activity was measured with the Disease Activity Score 28 using C-reactive protein (DAS28-CRP) [9, 10] and was also classified by the Clinical Disease Activity Index (CDAI) into the following groups: remission (<2.8), LDA (≥ 2.8 to < 10.0), moderate disease activity (MDA) (≥ 10.0 to < 22.0), and high disease activity (HDA) (≥ 22.0) [11]. Participants in the prospective substudy completed questionnaires at the research study visit. The Short-Form McGill Pain Questionnaire 2 (SF-MPQ-2) assesses pain descriptors, including six continuous (e.g., aching, throbbing), six intermittent (e.g., stabbing, piercing), six neuropathic (e.g., hot, burning), and four affective (e.g., punishing, fearful) descriptors, rated on an intensity scale of 0 to 3 [12]. The Fibromyalgia Research Survey includes the Widespread Pain Index (WPI), a measure of the number of painful body regions, and the Symptom Severity (SS) score, a measure of fatigue, unrefreshing sleep, cognitive symptoms, and other somatic symptoms [13]. The Polysymptomatic Distress Scale is the sum of WPI and SS scores on a continuous scale [14]. The Bristol Rheumatoid Arthritis Fatigue score assesses numeric rating scales from 0 to 10 for fatigue severity, effect, and coping, as well as a total score [15]. The Patient Health Questionnaire 9 (PHQ-9) is a reliable and valid measure of depression severity that scores each of the nine Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) criteria from 0 (not at all) to 3 (nearly every day) [16]. The protocol approved by the Mayo Clinic Institutional Review Board required that patients with PHQ-9 scores ≥ 10 be evaluated by the investigator and be given the option of primary care provider or psychiatry referral. The Generalized Anxiety Disorder 7 is a seven-item scale used to measure generalized anxiety symptoms [17]. The Mindfulness Attention and Awareness Scale is a 15-item scale designed to assess core characteristics of dispositional mindfulness and attention that are predictive of self-regulation and well-being [18]. Assessments were made from the Patient-Reported Outcomes Measurement Information System (PROMIS) 8a short forms for pain interference (version 1.0), sleep disturbance (version