Poor self-rated health is twice as common in rheumatoid arthritis: population-based evidence from the Paracelsus...

Self-rated health (SRH) is a simple but powerful predictor of morbidity and mortality. Its relevance in rheumatoid arthritis (RA) has not been systematically investigated in population-based cohorts. We analyzed 9,399 participants of the Paracelsus 10,000 study, including 293 (3.1%) with physician-diagnosed RA. SRH was assessed with a single-item global question. Associations of RA, sociodemographic, metabolic, and lifestyle factors with poor SRH were examined using multivariable logistic regression. Poor or very poor SRH was reported by 55% of RA participants compared with 31% of non-RA participants (p < 0.001). RA was independently associated with more than twofold higher odds of poor SRH (adjusted OR 2.21 (95% CI 1.61-3.02). Advanced age, metabolic syndrome, and current smoking were linked to worse SRH, whereas male sex, higher education, and higher physical activity were protective. Each one-point increase in Mediterranean diet adherence (PREDIMED score) was associated with a 4% lower odds of poor SRH (OR 0.96, 95% CI 0.94-0.99). No interaction between RA and diet adherence was observed. RA is strongly associated with poor self-rated health in the general population, after adjustment for comorbidities and lifestyle factors. Higher adherence to the Mediterranean diet and greater physical activity were linked to better perceived health, highlighting modifiable targets to improve patient-centered outcomes in RA.