Modifiable risk factors for RA: prevention, better than cure?

Area of Science:

• Rheumatology
• Epidemiology
• Lifestyle Medicine

Background:

• Inflammatory polyarthritis (IP) and rheumatoid arthritis (RA) are chronic autoimmune diseases with significant morbidity.
• Identifying modifiable lifestyle risk factors is crucial for developing effective prevention and management strategies.

Purpose of the Study:

• To synthesize existing evidence on modifiable lifestyle risk factors associated with inflammatory polyarthritis and rheumatoid arthritis.
• To inform potential population-level preventative strategies for RA.

Main Methods:

• A comprehensive MEDLINE literature search was conducted.
• Included case-control, cohort studies, and systematic reviews published from 1948 to February 2011.
• Rheumatoid arthritis diagnosis based on standard criteria served as the primary outcome measure.

Main Results:

• Smoking is a major contributor to RA, accounting for up to 25% of the population burden, with dose-dependent and sex-specific risks, particularly for anti-citrullinated peptide antibody-positive (ACPA(+)) RA.
• Smoking cessation benefits are delayed, with risk returning to baseline only after up to 20 years.
• Prospective data suggest protective effects of dietary antioxidants and breastfeeding, while high coffee consumption may increase RA risk. Inverse associations were noted with alcohol intake and higher education/social class, and increased risk with obesity in specific RA phenotypes.

Conclusions:

• Further large-scale prospective studies are needed to define RA phenotypes consistently (from undifferentiated IP to ACPA(+)/RF(+) disease).
• This research will enable the evaluation of population-based preventative strategies for RA, similar to those for cardiovascular disease and cancer, by targeting common risk factors.