• Change in Patient Health Questionnaire-9 (PHQ-9) [ Time Frame: 0, and 30 days ]
  The PHQ-9 is a nine-item depression self-report questionnaire for screening and measurement of severity of major depression. Scores range from 0-27 (Lower scores = Less depression).
• Change in Generalized Anxiety Disorder-7 (GAD-7) [ Time Frame: 0, and 30 days ]
  The GAD-7 is a seven-item self-report questionnaire for screening and measurement of severity of generalized anxiety disorder. Scores range from 0-21 (Lower scores = Less anxiety).
• Change in World Health Organization Well-Being Index (WHO-5) [ Time Frame: 0, and 30 days ]
  The WHO-5 Well-Being Index is a five-item self-report questionnaire covering 5 areas: positive mood, vitality, and general interests. Scores range from 0-25 (Higher scores = Higher levels of well-being).
• Change in Mindful Attention Awareness Scale (MAAS) [ Time Frame: 0, and 30 days ]
  The MAAS is a 15-item scale designed to assess a core characteristic of dispositional mindfulness. Scores range from 15-90 (Higher scores = Higher levels of mindfulness).
• Change in Sleep Condition Indicator (SCI) [ Time Frame: 0, and 30 days ]
  The SCI is a brief 8-item screening tool to evaluate insomnia disorder. Scores range from 0-32 (Lower scores = Greater sleep problems).
• Change in Social Connectedness Scale (SCS) [ Time Frame: 0, and 30 days ]
  The SCS is an 8-item questionnaire that assesses the degree to which people feel connected to others in their social environment. Scores range from 8 to 48. (Higher scores = More connectedness to others).
• Change in Eating and Appraisal Due to Emotions and Stress (EADES) [ Time Frame: 0, and 30 days ]
  The EADES is a 24-item sub-scale used to measure stress-related eating. Scores range from 24-120 (Lower scores = Greater emotion and stress-related eating).
• Change in Brief Pain Inventory (BPI) [ Time Frame: 0, and 30 days ]
  The BPI is an 8-item scale that assesses pain. Scores range from 0-10. (0 = No pain and 10 = Pain as bad as you can imagine).
• Change in Sheehan Disability Scale (SDS) [ Time Frame: 0, and 30 days ]
  The SDS is a 3-item measurement tool for assessing functional impairment in three inter-related domains: work/school, social, and family life. Scores range from 0-10 (Higher scores = Higher levels of functional impairment).
• Change in Cognitive and Physical Functioning Questionnaire (CPFQ) [ Time Frame: 0, and 30 days ]
  The CPFQ is a brief 7-item scale designed to assess cognitive and physical functioning. Scores range from 7-42 (Lower scores = Higher levels of cognitive and physical functioning).
• Change in HERO Wellness Scale [ Time Frame: 0, and 30 days ]
  The HERO Wellness Scale is a brief 5-item scale designed to measure four wellness traits plus perceived mental wellness. Scores range from 0-50 (Lower scores = Lower levels of mental wellness).
• Post-Program Participant Questionnaire [ Time Frame: 0, and 30 days ]
  A brief 6 question post study survey that captures participants' opinions about KickStart30.
• Change in Health Assessment Questionnaire-II (HAQ-II) [ Time Frame: 0, and 30 days ]
  The HAQ-II is a ten-item self-report questionnaire for assessing functional status in individuals with rheumatic disease. Scores range from 0-3.0 (Higher scores = Worse functioning and greater disability).

• Change in Patient Health Questionnaire-9 (PHQ-9) [ Time Frame: 0, and 30 days ]
  A self-reported depression scale used to assess severity of depression.
• Change in Generalized Anxiety Disorder-7 (GAD-7) [ Time Frame: 0, and 30 days ]
  A self-reported questionnaire used to assess anxiety symptoms.
• Change in World Health Organization-5 (WHO-5) [ Time Frame: 0, and 30 days ]
  A brief scale that measures mental well- being.
• Change in The Mindful Attention Awareness Scale (MAAS) [ Time Frame: 0, and 30 days ]
  A measure of mindfulness.
• Change in The Sleep Condition Indicator (SCI) [ Time Frame: 0, and 30 days ]
  A brief scale that evaluates insomnia disorder.
• Change in The Social Connectedness Scale (SCS) [ Time Frame: 0, and 30 days ]
  A brief scale that assesses the degree to which respondents feel connected to others.
• Change in Eating and Appraisal Due to Emotions and Stress (EADES) [ Time Frame: 0, and 30 days ]
  A scale assessing how individuals cope with and appraise stress in relation to food and eating.
• Change in The Mediterranean-Dietary Approaches to Stop Hypertension (DASH) Intervention for Neurodegenerative Delay (MIND) [ Time Frame: 0, and 30 days ]
  A combination of the Mediterranean and DASH (Dietary Approaches to Stop Hypertension) diets shown to lower a person's risk of developing Alzheimer's disease.
• Change in The Brief Pain Inventory (BPI) [ Time Frame: 0, and 30 days ]
  A measurement tool for assessing clinical pain.
• Change in The Sheehan Disability Scale (SDS) [ Time Frame: 0, and 30 days ]
  A measurement tool for assessing functional impairment in three inter-related domains: work/school, social and family life.
• Change in The Endicott Work Productivity Scale (EWPS) [ Time Frame: 0, and 30 days ]
  A brief self-report questionnaire designed to obtain a sensitive measure of work productivity.
• Change in Cognitive and Physical Functioning Questionnaire (CPFQ) [ Time Frame: 0, and 30 days ]
  A brief scale that measures cognitive and executive dysfunction.
• Change in The WILD 5 Wellness Scale (W5WS) [ Time Frame: 0, and 30 days ]
  A brief scale designed specifically for this project to measure wellness.
• Change in The WILD 5 Wellness Effort Scale (W5ES) [ Time Frame: 0, and 30 days ]
  A scale designed specifically for this project to measure weekly adherence with program elements.
• Change in The WILD 5 Wellness Elements Scale [ Time Frame: 0, and 30 days ]
  A scale designed specifically for this project to measure elements of depression, anxiety, wellbeing, mindfulness, sleep quality, social connectedness, emotional eating, diet practices, pain, disability, work productivity, happiness, enthusiasm, resilience, and optimism.
• The Post-Program Participant Questionnaire [ Time Frame: 0, and 30 days ]
  A brief post study survey that captures participants' opinions about WILD 5 Wellness: 90-Day Intervention, and subjective ranking of their overall wellness.

It is expected that this 30-day integrated, prescriptive, and trackable wellness intervention (combining five wellness elements including exercise, mindfulness, sleep, social connectedness, and nutrition) will be found to be an efficacious program for those with Rheumatoid Arthritis taking a biologic or a JAK inhibitor.

Traditionally mental health and other specialties like rheumatology have focused primarily on the diagnosis and treatment of illness rather than incorporating wellness as an essential element of treatment. Those in the helping professions are trained to diagnose health problems with treatment typically focusing on symptom reduction. More recently, mental health and other healthcare specialties like rheumatology have initiated a conversation and subsequent research focusing on the importance of integrating elements of wellness into treatment. Rather than focusing solely on symptom reduction, some providers have begun incorporating elements of wellness promotion into treatment with favorable results.

To the best of our knowledge, even though there is abundant research supporting each of the KickStart30 elements (exercise, mindfulness, sleep, social connectedness, and nutrition) individually, there is no research exploring the effectiveness of an integrated, prescriptive, and trackable wellness intervention combining these five elements specific to a cohort of patients with RA. Therefore, this work will be unique in that it will collect both objective and subjective data to assess the feasibility and effectiveness of this type of wellness intervention. It will lend support to the growing body of research on the efficacy of wellness interventions for a variety of different health conditions, as well as a community-based population. Finally, it is hoped that positive results will yield increased access to and utilization of this type of intervention, thereby improving public health.

The recruitment period will be open for 12 months to obtain a maximum of 50 participants. The study population will be individuals, ages 18 and older, interested in improving their overall wellness and that self-identify as having Rheumatoid Arthritis and taking a biologic or a JAK inhibitor. Each participant will be engaged in the program for 30 days. To determine a participant's eligibility, study personnel will conduct a preliminary screening/orientation telephone interview. If the participant is determined to be eligible for the study based on the preliminary screening/orientation phone interview, study personnel will collect the participant's email address, physical mailing address, and assign the participant a unique identification code based on the order in which the participant was screened. The consent form outlines the purpose and design of the study, data to be collected, confidentiality standards, alternatives to participation, and contact information for research personnel. Participants will have the option to download a PDF of their signed consent form for their records at the time of signing/completion.

Study personnel will mail each participant a KickStart30 Workbook within one day of emailing participants their unique identification codes. Participants will be instructed to document adherence of their daily wellness practices and their daily HERO exercises online via Qualtrics, an online survey software. Participants can document their daily adherence using their computer and/or their smartphone as Qualtrics offers a mobile version of the Participant Tracking Form. A copy of the Participant Tracking Form will also be available in the KickStart30 Workbook so participants that prefer keeping a daily paper log can do so, and they can then transfer their program adherence information to the online Participant Tracking Form at their convenience throughout the program. The workbook will contain the participant's personal identification code; no personal identification will appear in the workbook in order to protect participant confidentiality. Participants will also receive daily motivational emails from MailChimp, which will provide general information about one of the five wellness elements and/or one of the HERO wellness traits, as well as encouragement to track their participation on a daily basis, and encouragement to contact study personnel via email with any questions and/or concerns.

Data capture will occur at two points: once prior to beginning the study and again at the end of the 30-day study. Data will be collected online through program forms; all data will be hosted on Qualtrics, an online survey software. Program Forms assess items including depression, anxiety, wellbeing, mindfulness, sleep quality, social connectedness, emotional eating, pain, disability, physical function, happiness, enthusiasm, resilience, and optimism in patients with RA.

Descriptive statistics will be used to discuss pre- and post-intervention scores. Differences between pretest and 30-day measures will be assessed with repeated measures ANOVA, with a p value of less than 0.05 indicating statistical significance.

• Chronic Pain
• Stress
• Psychological
• Healthy
• Rheumatoid Arthritis

• Behavioral: Wellness Element 1 - Exercise
  Daily wellness element focusing on Exercise; adherence documented online daily
• Behavioral: Wellness Element 2 - Mindfulness
  Daily wellness element focusing on Mindfulness Meditation; adherence documented online daily
• Behavioral: Wellness Element 3 - Sleep Hygiene
  Daily wellness element focusing on sleep hygiene; adherence documented online daily
• Behavioral: Wellness Element 4 - Social Connectedness
  Daily wellness element focusing on Social Connectedness; adherence documented online daily
• Behavioral: Wellness Element 5 - Nutrition
  Daily wellness element focusing on Nutrition; adherence documented online daily
• Behavioral: Wellness Element 6 - Wellness Exercises
  Daily wellness workbook exercises focusing on improving mental wellness; adherence documented online daily
• Behavioral: Wellness Element 7 - Motivational Messages
  Daily motivational emails offering information on one of the 5 wellness elements each day (Exercise, Mindfulness Meditation, Sleep, Social Connectedness, and Nutrition)

Inclusion Criteria:

• Diagnosed with Rheumatoid Arthritis (RA) by a Rheumatologist
• Currently taking a biologic and/or a JaK inhibitor for the treatment of RA, including one or more of the following: Orencia (intravenous infusion or subcutaneous injection), Humira (subcutaneous injection), Kineret (subcutaneous injection), Cimzia (subcutaneous injection), Enbrel (subcutaneous injection), Simponi (subcutaneous injection), Simponi Aria (intravenous infusion), Remicade (intravenous infusion), Kevzara (subcutaneous injection), Rituxan (intravenous infusion), Actemra (intravenous infusion or subcutaneous injection), Olumiant (oral administration), Xeljanz (oral administration)
• Interested in improving overall wellness
• Not pregnant and no plans to get pregnant during the 30-day study
• English-speaking
• Must have access to a reliable Internet-enabled computer
• Must possess basic computer skills

Exclusion Criteria:

• Has not been diagnosed with RA by a Rheumatologist
• Not currently taking a biologic or a JAK inhibitor for the treatment of RA
• Not interested in improving overall wellness
• Pregnant or plans to get pregnant during the 30-day study
• Does not speak English
• Does not have access to a reliable, Internet-enabled computer
• Reports a lack of basic computer skills
• Acutely suicidal and/or actively psychotic