Background: Rheumatoid Arthritis (RA)constitutes a significant burden on rheumatology services in Sri Lanka with profound physical psychosocial and economic implications. Adequate patient knowledge about RA is critical for optimal care and reduction of disease and drug related complications. However, the level of knowledge among Sri Lankan RA patients remains underexplored. Existing international tools for knowledge assessment remain largely unsuitable for the local context due to cultural, linguistic, and comprehension differences. This study seeks to develop and pilot-test a simplified, culturally tailored questionnaire in Sinhala and Tamil to evaluate essential patient knowledge and identify key gaps to improve education and management strategies.

Objectives: To evaluate the knowledge of rheumatoid arthritis patients about their disease and its management in a tertiary care setting in Sri Lanka by developing a culturally appropriate self-administered questionnaire, adapted and improved from previously validated tools.

Methods: Essential knowledge was identified through a series of Delphi rounds with healthcare and non-Health care professionals and patients then reformulated to construct the final questionnaire. The English version was translated into Tamil and Sinhala by independent translators and retranslated for validity and clarity. Questionnaire was piloted at each stage to increase comprehension and reduce question bias. Patients at rheumatology clinics of National Hospitals Kandy were invited to participate in their preferred language, with assistance provided for those with reading, writing or visual impairments. Data were analyzed using Excel and SPSS software, with descriptive analysis for demographics and Pearson and Spearman correlation analyses to evaluate relationships between knowledge levels and continuous and ordinal variables and Mann-Whitney U test for assess differences across categorical variables. A 21- item Sri Lankan RA knowledge questionnaire (SRAQ) includes 9 demographic and 12 scored items (0-43), assessing knowledge of disease pathology, symptoms, complications, medications, side effects and life style factors, with each items deemed essential for all RA patients.

Results: A total of 325 patients participated in the study (291 females [89.5%],34 males [10.5%]). The majority were Sinhalese (282([86.8%), followed by Tamils (23 [7.1%]) and Muslims (19[5.8%]). Most patients identified Sinhala as their mother tongue (87.7%) with only 39 (12 %) reporting Tamil as theirs. Ages ranged from17 to 81 years with a mean of 57.1 ± 11.49 (Mode-56 y). While 104 (32.2%) patients had arthritis for more than 10 years, most have had the diagnosis for around 2 years. Educational level varied: 175 (54.3%) had completed ordinary level,71 (22%) only completed up to grade 5, and 9 (2.8%) had no formal education. Patient scores ranged from 0 to 35 out of 43, with a mean score of 13.52±6.94. Commonest score was 11. 3of the 7 patients who scored 0/43 had the diagnosis for over 10 years. The highest score of 35 was achieved by Sinhalese patients while the maximum score among Tamil patients was 22/43. Mean scores were higher for Sinhalese patients (13.67) compared to Tamil patients (11.28). There was a negative correlation between patient age and scores achieved (r=- 0.160, P<0.01) and a positive correlation between the total score vs educational level (r=0.117, P<0.05) and duration of disease in years (r=0.121, P<0.05). There was a significance difference of mean score ranks of Tamil and Sinhala speaking patients (P=0.028), however the same wasn’t observed across all educational categories. Statistical analysis revealed a negative correlation between age and scores (r = -0.160, P < 0.01) and positive correlations between scores and educational level (r = 0.117, P < 0.05) as well as disease duration (r = 0.121, P < 0.05). A significant difference in mean score ranks was observed between Tamil and Sinhala-speaking patients (P = 0.028). However, no significant differences in mean score ranks were observed across educational categories.

Conclusion: This culturally tailored and updated questionnaire is suitable for assessing disease-related knowledge in Sri Lankan Tamil and Sinhala speaking patients. It can be applied across diverse cohorts nationwide to improve validity. Our study cohort revealed a notably low disease related knowledge among RA patients. Despite varying education levels, all patients scored poorly, indicating widespread lack of understanding. Factors like educational levels and language proficiency, duration of disease may influence knowledge levels highlighting the need for targeted educational interventions to enhance self-management among RA patients.

REFERENCES: [1] Rodère M, Pereira B, Soubrier M, et al. Development and validation of a self-administered questionnaire measuring essential knowledge in patients with rheumatoid arthritis. Rheumatol Int . 2022;42(10):1785-1795.

[2] Hill J, Bird HA, Hopkins R, Lawton C, Wright V. THE DEVELOPMENT AND USE OF A PATIENT KNOWLEDGE QUESTIONNAIRE IN RHEUMATOID ARTHRITIS . Vol 30.; 1991.

Acknowledgements: Authors thank the expert panel involved in scrutinizing the questionnaire including Dr Duminda Munidasa (Senior consultant Rheumatologist, RRH), Dr Chathurika Dandeniya (Consultant Rheumatologist and Senior Lecturer, UOP), Dr Inosha Alwis (Lecturer department of Community Medicine UOP), and all other medical and non-medical personals involved in the Delphi rounds and the development of the questionnaire. Our appreciation to the Medical officers Dr E.R.Edman Godfrey, Dr Rinothja Rajaratnam, Non-medical professionals Dr AHM maujood, Dr T.F Raseen, Mrs Shiyana Nasim involved in Tamil and Sinhala translation and retranslation process and the medical officers, Nurses, physiotherapist, patients involved in the pilot study and who provided valuable feedback. Our gratitude is extended to Miss S.Y.Dharmaraj for assistance with statistical analysis.

Disclosure of Interests: None declared.

© The Authors 2025. This abstract is an open access article published in Annals of Rheumatic Diseases under the CC BY-NC-ND license ( http://creativecommons.org/licenses/by-nc-nd/4.0/ ). Neither EULAR nor the publisher make any representation as to the accuracy of the content. The authors are solely responsible for the content in their abstract including accuracy of the facts, statements, results, conclusion, citing resources etc.