Your patients may wonder what steps they can take to reduce their risk for rheumatoid arthritis (RA). As their health care professional, there’s a lot you tell them about risk reduction. 

There are risk factors for RA that are not related to genetics, as well as lifestyle choices that have the potential to increase the likelihood of getting the condition later in life. Some risk factors may come as little surprise to them, but others may be unexpected. You may want to discuss the following with them.

Smoking


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A 2021 study published in BMJ Open examined potential links between lifestyle factors such as smoking and RA incidence.¹ The researchers concluded that there is a consistent association between smoking and elevated risk for RA, both in former and current smokers. They also suggested that smoking may be a particular RA risk factor for women, especially those who have at least 10 pack-years of smoking in their history. 

Other studies have posited that smoking may increase seropositive RA risk by increasing inflammation and citrullination, and suggested that smoking cessation may reduce this risk over time.²

Alcohol

The relation between alcohol consumption and RA risk may not be what your patients think. Some studies have suggested that moderate alcohol consumption may actually reduce RA risk compared to patients who do not consume alcohol at all. A 2021 study in RMD Open examined the effects of alcohol and smoking on RA risk and found consumption of alcohol to be associated with as much as a 30% reduced RA incidence.³ 

It has been suggested that this may be due to the alcohol potentially decreasing proinflammatory cytokines.¹ However, it’s important to note that these effects are only observed with low-to-moderate consumption; higher levels of alcohol consumption can be dangerous and potentially bring about other health problems.

Weight

The researchers of the BMJ Open study also examined RA incidence in patients with a high BMI. They concluded that obesity is also a risk factor for RA, one that warrants further research amid increases in obesity worldwide.¹ Patients with an excess BMI, the investigators believe, may have inflammatory markers that have also been found in RA pathogenesis.

Diet

Although additional research into the potential link between diet and RA risk is needed, diet can play a large role in inflammation. A 2020 study in Nutrients looked at whether diet and nutrition play a role in RA development, and found that many dietary choices can have inflammatory effects while others could potentially have protective effects.⁴ In particular, red meat consumption and a high sodium intake can have a harmful inflammatory effect. Although the researchers did not find conclusive evidence of the Mediterranean diet or vitamin D consumption directly reducing the risk of RA, they do believe that their anti-inflammatory effects may still be effective protective markers and that more research into the subject is needed.

References

1. Ye D, Mao Y, Xu Y, Xu X, Xie Z, Wen C. Lifestyle factors associated with incidence of rheumatoid arthritis in US adults: analysis of National Health and Nutrition Examination Survey database and meta-analysis. BMJ Open. 2021;11(1):e038137. Published 2021 Jan 26. doi:10.1136/bmjopen-2020-038137

2. Zaccardelli A, Friedlander HM, Ford JA, Sparks JA. Potential of lifestyle changes for reducing the risk of developing rheumatoid arthritis: Is an ounce of prevention worth a pound of cure?. Clin Ther. 2019;41(7):1323-1345. doi:10.1016/j.clinthera.2019.04.021

3. Hedenstierna L, Bellocco R, Ye W et al. Effects of alcohol consumption and smoking on risk for RA: results from a Swedish prospective cohort study. RMD Open. 2021;7(1):e001379. doi:10.1136/rmdopen-2020-001379

4. Gioia C, Lucchino B, Tarsitano MG, Iannuccelli C, Di Franco M. Dietary habits and nutrition in rheumatoid arthritis: Can diet influence disease development and clinical manifestations?. Nutrients. 2020;12(5):1456. doi:10.3390/nu12051456