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felt that RA had a positive effect (as opposed to a neutral or negative effect) on these aspects, whereas lower proportions of patients considered this to be the case (31/83 [37%] and 29/84 [35%], respectively) Effect of RA on Work In total, 36 (42%) patients reported that they did not work, and two patients (2%) reported that their RA had forced them to take long-term leave or to retire RA was perceived to have led to a slowing of career progression by 22 patients (26%), equivalent to 45% (22/49) of all working patients. The majority of patients felt they were getting adequate physical and emotional support in the workplace (24/32 [75%] and 22/32 [69%] patients, respectively), whereas physicians were more neutral regarding adequate physical and emotional support in the workplace (9/20 [45%] and 8/20 [40%] HCPs, respectively) .In total, 43 of 82 patients (52%) described difficulty in using their hands as the greatest barrier to work, followed by emotional stress (39 [48%]), pain (31 [38%]), and fatigue (31 [38%]). Conversely, HCPs felt pain was the greatest obstacle to work (11/22 [50%]), followed by emotional stress (10/22 [45%]), fluctuation of the disease (10/22 [45%]), difficulty using hands (9/22 [41%]), and ability to get to and from work (9/22 [41%]) (Supplementary Figure 3). Difficulty using hands was the greatest obstacle to working among females (67%) but not among males (30%); for males, the most frequently reported obstacle to working was emotional stress (70 vs 33% for females) (Supplementary Effect of RA on Everyday Activities Pain was considered one of the most common barriers to undertaking everyday activities, by 50/85 patients (59%) and 17/21 HCPs (81%). Fatigue and aching/stiff joints were also commonly perceived as a barrier. Difficulty using hands was considered almost equally important by patients and HCPs, whereas emotional stress related to RA and lack of self-confidence were more commonly reported as a barrier by patients .The most common everyday activities cited as difficult to perform were exercise (35/83 patients [42%]; 6/21 HCPs [29%]) and housework (19/83 [23%]; 13/22 [59%], respectively). The impact of RA was perceived as greater by HCPs than patients on sex and intimacy (8/20 [40%] vs 10/81 [12%], respectively) and washing/personal grooming (8/21 [38%] vs 8/82 [10%], respectively) Patients most commonly reported feeling anxious (50/85 [59%]) or frustrated (27/85 [32%]) about being unable to accomplish tasks because of RA, whereas HCPs cited anxiety (9/22 [41%]), isolation (9/22 [41%]), and frustration (8/22 [36%]) as being the most likely feelings. Effect of RA on Aspirations When asked how they would like to feel about RA in the future, 34 of 85 patients (40%) responded that they would like to accept their RA despite the barriers it caused, whereas 17 (20%) felt that RA was part of who they were, and 17 (20%) hoped to live their lives in the same way as those without RA. A further 14 patients (16%) recognized that RA hindered their lives but accepted it, and only 3 (4%) could not accept having the disease. Patients most commonly reported hoping that people in their lives would better understand the emotional impact of RA (41/83 [49%]), but this was highlighted by only 6/23 HCPs (26%) (Figure 4). HCPs considered the aspiration most likely to be chosen by patients was that people in their lives would better understand the physical impact of RA (14/23 [61%]), but only 28/83 patients (34%) cited this aspiration. In addition, 13/23 HCPs (57%) believed that patients hoped their doctor would take more interest in what they considered to be important with respect to their treatment, whereas only 21/83 patients (25%) reported this aspiration. The most important activity for patients was being able to go out with friends (54/81 patients [67%] vs 10/22 HCPs [45%]), whereas
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