Practicing at least four of five key healthy lifestyle behaviors can reduce women’s risk of rheumatoid arthritis (RA) by more than 30%, according to a new study.
Over the years, researchers have identified a variety of lifestyle-related RA risk factors, but it has been unclear to what degree modifying them might reduce disease risk. The authors of a 2019 Clinical Therapeutics literature review of the evidence for links between lifestyle factors and RA risk concluded that a variety of lifestyle factors can affect RA risk, but that more research was needed to understand how modifying these factors affects risk.
The Power of Healthy Choices
Karen Costenbader, MD, MPH, Professor of Medicine at Harvard Medical School, Michael E. Weinblatt, MD Distinguished Chair in Rheumatology, Inflammation, and Immunity, and Lupus Program Director at Brigham and Women’s Hospital, and colleagues sought to better understand how healthy behaviors might protect against RA. The researchers analyzed data on nearly 250,000 women from the Nurses’ Health Study and Nurses’ Health Study II. Participants received a healthy lifestyle index score (HLIS) based on five behaviors:
- Body mass index of 18.5 to 24.9
- Healthy diet (highest 40th percentile of the Alternative Healthy Eating Index)
- Moderate alcohol intake (5 to 15 grams per day)
- Never smoking
- Regular exercise (19 or more metabolic equivalent of task hours per week)
The researchers found 1,219 incident RA cases over more than 4 million person-years. Women with higher HLIS had lower overall, seropositive and seronegative RA risks. Having at least four healthy lifestyle factors yielded a population-attributable RA risk reduction of 34%. The study was published in Arthritis Care & Research.
“All of those [lifestyle factors] are public health messages that we hear a lot for the prevention of cancer and cardiovascular disease,” Dr. Costenbader says. “But now, we found a very strong signal, and the modeling was very clear, that the healthier you get, the lower the risk of rheumatoid arthritis is, which is a very exciting message.”
Clinicians may now be able to deliver a more hopeful message about risk reduction. Where once they had to tell patients there was not much they could do to avoid RA, Dr. Costenbader says, now they can recommend lifestyle-related steps to reduce risk.