Introduction The risk for cardiovascular diseases and other comorbidities increases with the number of unhealthy lifestyle factors in the general population. However, information on the combined number of unhealthy lifestyle factors in people with rheumatoid arthritis (RA) is scarce. Objectives To study lifestyle factors and the association between disease impact and two or more unhealthy lifestyle factors in two Scandinavian cohorts with RA. Methods We analysed data from two cohorts, Danish (n = 566; mean age 61.82 (SD 11.13) years; 72% women) and Swedish (n = 955; mean age 66.38 (SD 12.90) years; 73% women). Lifestyle factors (tobacco use, BMI, alcohol consumption and physical activity) were dichotomised as healthy vs. unhealthy (range 0–4 unhealthy factors). The association between disease impact and two or more unhealthy lifestyle factors was analysed using logistic regression. Results Sixty-six percent of Danish and 47% of Swedish respondents reported two or more unhealthy lifestyle factors, most commonly, being overweight/obese and physical inactivity. For Danish participants, two or more unhealthy lifestyle factors were associated with (OR and 95% CI) male gender (1.86; 1.21–2.85), cardiovascular diseases (1.90; 1.28–2.82) and disease duration (0.97; 0.95–0.99). Corresponding findings for the Swedish cohort were male gender (1.42; 1.07–1.89), pain (1.10; 1.04–1.15), fatigue (1.09; 1.04–1.15), physical functioning (1.64; 1.28–2.10) and quality of life (0.35; 0.20–0.60). Conclusion Many patients, most often male, in both cohorts had two or more unhealthy lifestyle factors. The number of unhealthy lifestyle factors indicates a multifaceted relationship with disease impact. Key Points• This article contributes with new information concerning the proportion of patients with RA who have one or more unhealthy lifestyle factors.• Every second patient in the two included cohorts reported two or more unhealthy lifestyle factors.• Two or more unhealthy lifestyle factors were more common in men than in women but were not necessarily associated with measures of disease impact.• In order to adhere to a healthier lifestyle, a large proportion of the patients need to change more than one lifestyle habit, which entails a challenge for both the patients and the health professionals.

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Background:In people with rheumatoid arthritis (RA), modifiable lifestyle factors such as smoking, being overweight/obese, alcohol overuse and physical inactivity may not only affect treatment response and quality of life, but can also increase the risk for cardio-vascular diseases and other comorbidities (1,2). Evidence and EULAR guidelines (3) support lifestyle changes in patients with RA. If a patient need to change several habits, the challenge may seem overwhelming and substantial support will be needed. There is little information concerning the prevalence of a combined number of unhealthy lifestyle (UL) factors in people with RA.Objectives:I) To study the prevalence of unhealthy lifestyle factors in two Scandinavian RA cohorts. II) To study the association between disease impact and two or more unhealthy lifestyle factors.Methods:Patients diagnosed with RA who participated in a cardiovascular screening consultation at a specialist clinic during 2016-2018 and responded to four lifestyle questions, constituted the Danish cohort (data retrieved from the national registry DANBIO). Patients with RA belonging to the BARFOT cohort, and who in a 2017 survey responded to four lifestyle questions, constituted the Swedish cohort. Lifestyle information was dichotomized as present tobacco use or not, BMI <25 kg/m2 vs. ≥25 kg/m2, alcohol overuse or not, and health enhancing physical activity (≥ 150 minutes/week) or less. The combined number of UL factors (0, 1, 2, 3, 4) were calculated. Crude logistic regression analyses were performed to determine the association between disease impact and two or more UL factors (controlled for age, gender and disease duration). Independent factors (disease impact) were pain (NRS 0-10, best to worst), fatigue (NRS 0-10, best to worst), function (HAQ, 0-3, best to worst) and quality of life (EQ-5D-3L 0-1, worst to best).Results:The 566 included Danish patients had a mean age of 61.82 (SD 11.13) years, a disease duration of mean 12.40 (SD 10.95) years, and 72% were women. The 995 Swedish patients had a mean age of 66.38 (SD 12.90) years, a disease duration of mean 15.55 (SD 3.85) years, and 72% were women. 95% of the Danish patients and 82% of the Swedish patients reported at least one UL factor, while 66% and 47% respectively reported two or more (Figure 1). The most common ones were overweight/obesity and physical inactivity in both cohorts. Male gender OR 1.86 95% CI [1.21-2.85] and shorter disease duration OR 0.97 95% CI [0.95-0.99] were associated with two or more UL factors in the Danish cohort. In the Swedish cohort, male gender OR 1.42 95% CI [1.07 – 1.89], worse pain OR 1.10 95% CI [1.04 – 1.15], fatigue OR 1.09 95% CI [1.04 – 1.15], function OR 1.64 95% CI [1.28 – 2.10], and worse quality of life OR 0.35 95% CI [0.20 – 0.60] were associated with two or more UL factors.Conclusion:Every other patient with RA had two or more UL factors in both the Danish and Swedish cohort, and more often they were men. The combined number of UL factors was not necessarily associated with disease impact. The findings are important for health professionals working with lifestyle interventions in patients with RA.Figure 1.The combined number of unhealthy lifestyle (UL) factors in two Scandinavian RA cohorts.References:[1]Smolen JS, Landewé RBM, Bijlsma JWJ, Burmester GR, Dougados M, Kerschbaumer A, et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2019 update. Ann Rheum Dis. 2020;79(6):685-99.[2]Lindhardsen J, Ahlehoff O, Gislason GH, Madsen OR, Olesen JB, Torp-Pedersen C, et al. The risk of myocardial infarction in rheumatoid arthritis and diabetes mellitus: a Danish nationwide cohort study. Ann Rheum Dis. 2011;70(6):929-34.[3]Agca R, Heslinga SC, Rollefstad S, Heslinga M, McInnes IB, Peters MJ, et al. EULAR recommendations for cardiovascular disease risk management in patients with rheumatoid arthritis and other forms of inflammatory joint disorders: 2015/2016 update. Ann Rheum Dis. 2017;76(1):17-28.Disclosure of Interests:None declared