Google Internet Searches Related to Inflammatory Arthritis: an Observational Study Using Google Trends Data

Background/Aims Inflammatory arthritis (IA) care involves a paradox. Rheumatologists focus on reducing disease activity through treat-to-target (T2T). But surveys/qualitative studies show patients' main concern is pain. As these studies include a minority of patients, their findings may not be generalisable. The internet has transformed how patients access health information. Examining search engine data provides an alternative method to understand the health areas of most importance to people with IA. We examined publicly available Google search engine data, to determine the relative popularity of searches for different aspects of health made in conjunction with IA. Methods We used Google Trends data from 2011-2022 to determine the relative popularity of searches for "patient symptom" (pain; work; stiffness; fatigue; mood) and "T2T" (DMARDs; inflammation; synovitis; corticosteroids) domains made with rheumatoid arthritis (RA), psoriatic arthritis (PsA), and ankylosing spondylitis (AS) in the UK/USA. Google Trends normalises a sample of search data by popularity over time and region, presenting it on a 0-100 scale at each time-point (100 represents the time-point with most searches). It allows comparisons of up to five search term combinations. We evaluated >100 search term combinations to ascertain the most popular "patient symptom" and "T2T" domains (comparing mean normalised scores across time-points). Results Patient Symptom Domains: in all IA forms in the UK/USA, pain was the most popular term. Its popularity increased over time. UK searches for pain gave mean scores of 58, 34, and 39 with RA, PsA, and AS. UK searches for other patient symptom domains gave mean scores ranging 2-7 with RA; no scores were generated with PsA/AS. In the USA, pain gave mean scores of 79, 51, and 63 with RA, PsA, and AS, compared to scores ranging 2-6 for other domains. T2T Domains: methotrexate was the most popular search term with RA and PsA in the UK (mean 28 and 21) and USA (mean 63 and 33); it was only slightly more popular than searches for synovitis and inflammation. For AS, in the UK and USA inflammation was most popular (mean 9 and 34). Most Popular Patient Symptom vs Most Popular T2T Domain: for RA, PsA, and AS, pain was substantially more popular in the UK (mean 58, 30, 52) and USA (mean 79, 54, 63) than methotrexate in RA and PsA in the UK (mean 16 and 14) and USA (mean 15 and 11) and inflammation in AS in the UK (mean 6) and USA (mean 8). Conclusion Pain is the most popular search term used with IA in Google searches in the UK/USA, supporting surveys/qualitative studies showing pain is the health aspect of most importance to people with IA. Routine pain assessments should be embedded within T2T strategies to ensure patient perspectives are considered. Disclosure M. Akthar: Grants/research support; 'M.A. previously received funding by the National Institute for Health and Care Research (NIHR Academic Clinical Fellowship in Rheumatology)., The views expressed are those of the author and not necessarily those of the NIHR, NHS or the Department of Health and Social Care.'. K.J. Mason: Grants/research support; 'K.J.M. is funded by the National Institute for Health and Care Research (NIHR; Grant Reference Number NIHR203281)., The views expressed are those of the author and not necessarily those of the NIHR, NHS, or the Department of Health and Social Care.'. I.C. Scott: Grants/research support; 'I.C.S. is funded by the National Institute for Health and Care Research (NIHR Advanced Research Fellowship, NIHR300826). , The views expressed are those of the author and not necessarily those of the NIHR, NHS, or the Department of Health and Social Care.'