Table 2 Clinicians’ decision process

Preferred Treatment Approach

“I typically sort of set up a menu of possibilities, all of which are within that evidence-based realm, and I’m fairly comfortable with choices they make.” Clinician 9

“Well, so in my own mind, I have a certain approach I use… it’s divided up into kind of immediate short-term treatment and then also treatments that would address long-term disease control.” Clinician 10

“So it all depends on how they present, what phase they get to us, how many joints, how much disability, how much systemic disease, and then try to be aggressive at first to get the thing under control.” Clinician 12

“…now there’s treatment guidelines, so that makes it easier. I mean, kind of a step-wise approach.” Clinician 14

Timing of Decision

“So after diagnosis has been reached I go through the different types of medications that we use to and I usually start by talking about the more benign medications.” Clinician 2

“A treatment plan can always change … whether it’s side effects or flare-up of disease or something like that or new medical literature that comes out.” Clinician 3

“If it’s recurrence of disease after a long period of being quiet, you need to know what the family has been through before…” Clinician 9