Objective <p>Text-based messaging support can improve rheumatoid arthritis (RA) care delivery by connecting patients with healthcare providers (HCPs) in an efficient and convenient manner. However, the nature and appropriateness of patient messaging in this new care model are unknown. The aim of this study was to (1) analyze the frequency and nature of text messages patients sent to their HCPs, and (2) to identify patient characteristics associated with higher texting frequency in a pilot of a text-based messaging (using the WelTel platform) added to usual rheumatology care.</p> Methods <p>Seventy patients with RA participated in a 6-month pilot. Automated “How are you?” texts were sent monthly, and patients were encouraged to respond according to their current situation. Qualitative content analysis was conducted to thematically categorize and quantify common words and phrases. Regression analysis was conducted to determine if a relationship existed between the number of text messages and age, sex, care complexity (using a validated instrument), number of medications, and burden of comorbidities.</p> Results <p>A total of 1404 text messages were sent by patients, with 257 messages requiring a response. Three main themes for texting topics emerged: RA symptom reporting, medication management, and COVID-19 questions. Patients with higher care complexity had a higher frequency of texting (<i>p</i> = 0.025); however, no association was observed with other patient characteristics.</p> Conclusion <p>Patients with higher complexity texted HCPs more frequently. Messages were highly aligned with patient care needs. Future directions should include assessing the impact of text messaging-enhanced care on patient outcomes and overall healthcare utilization.</p> Clinical trial number <p>Not applicable.</p>