Potential of Lifestyle Changes for Reducing the Risk of Developing Rheumatoid Arthritis: Is an Ounce of Prevention Worth a Pound of Cure?

Abstract

Purpose: Lifestyle may be important in the development of rheumatoid arthritis (RA). Therefore, changing behaviors may delay or even prevent RA onset. We reviewed the evidence basis for the associations of lifestyle factors with RA risk and consider future directions for possible interventions to reduce RA risk. Methods: We reviewed the literature for cross-sectional studies, case-control studies, cohort studies, and clinical trials investigating potentially modifiable lifestyle factors and RA risk or surrogate outcomes on the path towards development, such as RA-related autoimmunity or inflammatory arthritis. We summarized the evidence related to cigarette smoking, excess weight, dietary intake, physical activity, and dental health for RA risk. Findings: Cigarette smoking has the strongest evidence base as a modifiable lifestyle behavior that increases seropositive RA risk. Smoking may increase seropositive RA risk through geneenvironment interactions, increasing inflammation and citrullination locally in pulmonary/oral mucosa or systemically, and thereby inducing RA-related autoimmunity. Prolonged smoking cessation may reduce seropositive RA risk. Evidence suggests that excess weight may increase RA risk, though this effect may differ by sex, serologic status, and age at RA onset. The effect of dietary intake may also impact RA risk: overall healthier patterns, high fish/omega-3 polyunsaturated fatty acids, and moderate alcohol intake may reduce RA risk, while caffeine and sugar-sweetened soda may increase RA risk. The impact of physical activity is less clear but high levels may reduce RA risk. Periodontal disease may induce citrullination and RA-related autoimmunity, but the effect of dental hygiene behaviors on RA risk is unclear. Although the effect size estimates for these lifestyle factors on RA risk are generally modest, there may be relatively large public health benefits for targeted interventions given the high prevalence of these unhealthy behaviors. With the exception of smoking cessation, the impact of behavior change of these

Patients’ and rheumatologists’ perceptions on preventive intervention in rheumatoid arthritis and axial spondyloarthritis

“…This has enabled the development of prediction models aiming to identify individuals with a high risk of developing RA who qualify for preventive intervention [3,4]. Environmental factors including lifestyle are important in RA development and lifestyle intervention may delay or prevent RA onset [5][6][7]. In addition, several placebo controlled clinical trials in individuals at increased risk of RA have been performed or are ongoing [8][9][10].…”

The Influence of Socio-Demographic Factors, Lifestyle and Psychiatric Indicators on Adherence to Treatment of Patients with Rheumatoid Arthritis: A Cross-Sectional Study

“…Despite new pharmacological strategies, patients with RA still report unmet needs due to symptoms that remain unaddressed [3]. Some lifestyle factors (bulimia, cigarette smoking, alcohol intake, caffeine and sugar-sweetened soda consumption) were reviewed as they may affect RA risk [4] and some (dietary interventions) were investigated to verify whether they improve RA symptoms [5]. Alcohol intake for RA patients treated with methotrexate and leflunomide, that are potentially hepatotoxic, could increase the risk of cirrhosis.…”

Effects of alcohol consumption and smoking on risk for RA: results from a Swedish prospective cohort study

“…Since few participants reported high alcohol consumption, according to the classification that is used by Statistics Sweden, we were not able to further analyse whether the inverse dose–response relationship was interrupted at a certain level of alcohol intake, which has been demonstrated previously. 4 11 …”

“… 2 3 However, the impact of alcohol consumption on RA risk remains poorly understood. Several studies have indicated an inverse relationship between alcohol consumption and RA risk, 4–7 although results have not been consistent. 8 9…”