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OBJECTIVE: To determine the health literacy of patients with rheumatoid arthritis (RA) attending community-based rheumatology practice. METHODS: Eighty patients were administered the Test of Functional Health Literacy in Adults (TOFHLA), a 50-item reading comprehension and 17-item numerical ability test (score 0-100); the Rapid Estimate of Adult Literacy in Medicine (REALM), which asks participants to read aloud 66 words of varying difficulty (score 0-66); and the Test of Reading Comprehension (TORCH), which asks participants to read a short text and then fill in the gaps of another version by using one or more of their own words (score 1-9). RESULTS: The study group included 60 women (75%), mean age (SD) 60.29 (15.02) years, median duration of RA 8 years (range 0.3-39). Nineteen of 80 (24%) had completed <or= 8 years of formal education, 24/80 (30%) had completed 9 or 10 years, and 37/80 (46%) had completed >or= 11 years. TOFHLA and REALM scores ranged from 39-100 and 41-66 respectively. Scores for 8 patients (10%) indicated they would have difficulty reading and interpreting health texts and struggle with most currently available patient education materials. Of those who attempted the TORCH, 8/65 (12%) scored low or below average and 23/65 (35%) scored average compared with students completing 9th grade. All 3 literacy tests were significantly correlated with education level, but use of educational level alone as a measure of literacy would have misclassified more than 10% as health literate/illiterate. CONCLUSION: A significant number of patients with RA have limited health literacy and may not understand even simple written instructions or prescription labels.