Abstract
Background: Rheumatoid arthritis (RA) is a serious autoimmune disease which causes painful, swollen joints and can impact quality of life and increase morbidity and mortality. There are several preclinical stages of RA that correspond to at-risk groups that include: genetic risk, risk from behaviors, elevation of RA-related autoantibodies, and early clinical disease manifestations such as undifferentiated arthritis. Early interventions are crucial to slowing progression to and potentially preventing RA onset. Modification of behaviors among at-risk individuals may decrease RA risk. There are several challenges and opportunities in implementing preventative behavioral interventions, which may vary within different at-risk groups. Methods: We performed a narrative review of the literature, including meta-analyses focused on RA risk-related behaviors as well as publications investigating the potential efficacy of behavioral modifications on RA risk. Results: There are multiple behavioral risk factors associated with RA, including smoking, obesity, low physical activity, low quality diet, and poor dental hygiene, which may contribute to progression to clinical RA. Meta-analyses have been performed for smoking, excess body weight, and physical activity. Likelihood of adopting behavioral modifications may increase as RA risk increases. Conclusions: Clinicians may be able to tailor preventative approaches to various RA at-risk groups to help reduce RA risk, but further research is needed. A better understanding of the relationship of behaviors with RA risk and optimized approaches to implementing behavioral changes may allow for clinicians to tailor their preventative approaches for at-risk individuals.
Highlights
There are several phases of development of Rheumatoid arthritis (RA) prior to full clinical onset
Case-control studies in the general population have found that behavioral risk factors include cigarette smoking [3], inhalant-related occupations [4], obesity [5,6,7,8], low physical activity [9], lowquality diet [10], poor dental hygiene [11], maintenance of an abnormal microbiome [12,13], and lack of treatment for psychologic conditions like PTSD [14] and depression [15], habits which confer varying degrees of RA risk [16] (Table 1)
These behaviors may interact with other RA risk factors, such as genetics, to increase overall RA risk [16]
Summary
There are several phases of development of RA prior to full clinical onset. Groups within these risk phases may have different likelihood of RA onset. Individuals in certain risk groups may be targets of preventative approaches for RA. These RA at-risk groups include: genetic risk, behavioral risk, systemic autoimmunity (presence of RA-related biomarkers), and presence of clinical RA-related disease manifestations. Behavioral modifications and preventative measures, even before systemic autoimmunity and joint involvement [1], are crucial to prevent rheumatoid arthritis progression. By evaluating each RA at-risk group and the potential promotors and barriers for preventative changes, clinicians can better understand how to tailor efficient targeted preventative therapeutic approaches. There are several preclinical stages of RA that correspond to at-risk groups that include: genetic risk, risk from behaviors, elevation of RA-related autoantibodies, and early clinical disease manifestations such as undifferentiated arthritis. Interventions are crucial to slowing progression to and potentially preventing RA onset. Results: There are multiple behavioral risk factors associated with RA, including smoking, obesity, low physical activity, low quality diet, and poor dental hygiene, which may contribute to progression to clinical
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
