Abstract
Purpose
Lifestyle may be important in the development of rheumatoid arthritis (RA). Therefore,
changing behaviors may delay or even prevent RA onset. This article reviews the evidence
basis for the associations of lifestyle factors with RA risk and considers future
directions for possible interventions to reduce RA risk.
Methods
The literature was reviewed 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 toward development such as RA-related
autoimmunity or inflammatory arthritis. The evidence related to cigarette smoking,
excess weight, dietary intake, physical activity, and dental health for RA risk were
summarized.
Findings
Cigarette smoking has the strongest evidence base as a modifiable lifestyle behavior
for increased seropositive RA risk. Smoking may increase seropositive RA risk through
gene–environment interactions, increasing inflammation and citrullination locally
in pulmonary/oral mucosa or systemically, thereby inducing RA-related autoimmunity.
Prolonged smoking cessation may reduce seropositive RA risk. Evidence suggests that
excess weight can increase RA risk, although this effect may differ according to sex,
serologic status, and age at RA onset. TDietary intake may also affect RA risk: overall
healthier patterns, high fish/omega-3 polyunsaturated fatty acid consumption, and
moderate alcohol intake may reduce RA risk, whereas caffeine and sugar-sweetened soda
consumption might increase RA risk. The impact of physical activity is less clear,
but high levels may reduce RA risk. Periodontal disease might 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 lifestyle factors on
subsequent RA risk has not been established. Nearly all of the evidence for lifestyle
factors and RA risk were derived from observational studies.
Implications
There are many potentially modifiable lifestyle factors that may affect RA risk. Improving
health behaviors could have large public health benefits for RA risk given the high
prevalence of many of the RA risk-related lifestyle factors. However, future research
is needed to establish the effects of lifestyle changes on RA risk or surrogate outcomes
such as RA-related autoimmunity or inflammatory arthritis.
Key words
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Article info
Publication history
Published online: June 09, 2019
Accepted:
April 11,
2019
Received in revised form:
March 26,
2019
Received:
February 6,
2019
Identification
Copyright
© 2019 Published by Elsevier Inc.
