OBJECTIVES: To describe the shared decision-making process between patients and physicians when initiating biologic therapy for the treatment of rheumatoid arthritis (RA) from the patient perspective. METHODS: Patients self-reporting a diagnosis of RA completed a self-administered, internet-based questionnaire in the Fall of 2011. A subset of patients currently using a biologic therapy to treat their RA provided details about the decision-making process for initiating their current therapy.  RESULTS: A total of 2138 respondents (76% female, mean age 56.4) completed the questionnaire.  Of these, 20% (n=434) were currently being treated with biologic therapy.  Discussions about biologic therapy were most often initiated by a rheumatologist (91%); only a small proportion of patients reported that a primary care physician (4%), the patient themselves (3%), or another (2%) initiated the discussion.  During the discussions, physicians most often focused on administration (77%), dosing schedule (77%), side effects (71%), safety risks (64%), importance of long-term use (57%), and importance of concomitant methotrexate use (53%).  Patients rated the following as very or extremely influential (4 or 5 on a 5-point Likert scale) on the final decision to initiate biologic therapy: advice or recommendation by physician (76%), co-pay assistance to cover out-of-pocket costs (31%), advice or recommendation from other healthcare professional (28%), patient literature materials from physician office (27%), and  information from general websites (22%).  Most patients (71%) reported making the decision to start biologic therapy at the time of the initial discussion with their physician; mean time for all patients to make a decision to start biologic therapy was 12.2 days from the time of initial discussion. CONCLUSIONS: Rheumatologists are best positioned to ensure that patients have the necessary information to actively engage in the shared decision-making process for initiating biologic therapy.  Future research should focus on potential outcomes benefits of shared decision-making.