Are You at Risk For Rheumatoid Arthritis?
For everything doctors understand about rheumatoid arthritis—and they know a lot—the exact cause of this autoimmune disease that attacks the inner lining of joints and causes body-wide inflammation remains a mystery. So for now, when talking about RA prevention, doctors focus on the risk factors that may increase your odds. Simply having a risk factor doesn’t mean that you’ll develop the condition, however. And sometimes it’s possible to lower or even eliminate certain risks. There’s really a lot at play with RA, so let’s look at the risk factors you can change (and the ones you can’t).
Having a first-degree relative (parent, sibling or child) with RA roughly doubles the odds that you will get the disease, says David Batt, M.D., a rheumatologist at Indiana University Health in Indianapolis. For some people, this may mean that you have variations in a complex of genes, known as HLA genes, that are linked to RA. While Dr. Batt does not recommend genetic testing for those with a family history, he does suggest talking to your doctor about lifestyle changes that could be beneficial—as factors like smoking, obesity, and stress can all increase your genetic risk. (More on these in a few.)
As you get older, your chances of developing rheumatoid arthritis rise, just as the risk for many other health conditions increases with age. But keep in mind that RA isn’t an older person’s disease. Younger people may also be diagnosed with the condition, so age isn’t a stand-alone factor. In fact, Dr. Batt says he sees many patients who are women between 20 and 40.
There’s a reason Dr. Batt’s sees a lot of female patients: Women are more likely to have rheumatoid arthritis than men. One 2017 study, which looked at RA characteristics and risk factors among a group of 8,789 people in the U.S., found that 61% of the people with RA were women. “Hormones play a role in RA, especially estrogen,” explains Stuart Kaplan, M.D., chief of rheumatology at Mount Sinai South Nassau hospital in Oceanside, NY. The connection isn’t fully understood, but as one example, Dr. Kaplan notes that many women see their RA symptoms worsen towards the end of their monthly menstrual cycle.
Being a Smoker
People who light up put themselves at greater risk for any number of diseases—not only heart disease and cancer but also autoimmune diseases like rheumatoid arthritis. There is growing evidence that the lungs can be a trigger of RA, and that the irritation and inflammation from smoking can contribute to this. Cigarettes may cause immunological changes in smokers in a variety of ways, potentially triggering RA. “I always encourage all of my patients to stop smoking and also encourage them not to vape, since the health risks are unknown,” says Lynn Ludmer, M.D., medical director of rheumatology at Mercy Medical Center in Baltimore. Smoking can also decrease the effectiveness of several medications used to treat the condition, Dr. Ludmer adds.
“RA is more likely to develop, or be more aggressive, for individuals who are obese,” Dr. Batt says. The more pounds you carry, the more pressure on your joints, and experts theorize that fat cells may also release inflammatory proteins throughout the body. Thus the heavier you are, the more your chances of developing RA increase. Obese people with RA also have poorer outcomes, more pain, and worse overall health, a study in Arthritis Care and Research found. Treatment may be trickier, too: Studies suggest some RA medications may be less effective when those taking them are overweight or obese.
The 2017 study on RA risk factors found that having osteoporosis carries a four-fold increased risk for RA. Other research has shown that people with RA who have more than one health condition may also be likely to have osteoporosis. What may be behind the connection? Steroid use and inactivity, Dr. Ludmer says. Regular exercise, especially weightbearing such as walking or dancing, can help prevent both bone loss and joint stiffness.
Exposure to Secondhand Smoke During Childhood
If your parents smoked around you when you were growing up, you may be at increased risk for RA, according to a French study in Rheumatology. There was about a 40% increase in risk among people who never smoked themselves yet were exposed during childhood. Meanwhile, smokers who were exposed to secondhand puffs as kids had a 67% higher chance of developing RA than smokers who weren’t exposed when they were young—and the condition developed earlier in life.
Emotional and Physical Stress
Too much stress isn’t good for your overall health, and it may be a risk factor for many conditions, including depression, diabetes and heart disease. Experiencing chronic stress may also increase your risk of RA by leading to changes in the immune system. “Emotional and physical stress can trigger RA for those who are already genetically predisposed to it,” Dr. Batt says. “Sometimes it’s a result of constant physical work.” Consider taking steps to lower your agitation level, such as meditation, regular exercise, counseling, and if you can, avoiding work that overtaxes you physically or mentally.
Living in Poverty
Factors like chronic stress, smoking, and obesity may be associated with living in poverty, which may in turn increase the risk of rheumatoid arthritis. “Unfortunately, many poor or under-insured people in our society do not have adequate access to good medical care, especially rheumatologists,” Dr. Kaplan adds. “Therefore, there is often a long delay in their getting properly diagnosed and treated. Also, they may have difficulty obtaining some of the newer RA treatments, which are extremely expensive.” (Visit healthcare.gov to see if you qualify for free or subsidized health insurance.)
How to Decrease Your Risk Factors
You can’t change your family history, gender, or age. But you can change habits linked to RA. “A healthy lifestyle with no smoking, maintaining a healthy weight, and reducing stress makes it less likely that these genetic variations will be activated,” Dr. Batt says. “If you’re a smoker, explore the different options and resources for quitting. Try to maintain a diet that’s low in sodium and sugar, and talk to your doctor about the right diet and exercise plan that goes with your lifestyle and health needs.”
RA Risk Factors: PeerJ. (2017). “Characteristics and Risk Factors of Rheumatoid Arthritis in the United States: An NHANES Analysis.” ncbi.nlm.nih.gov/pmc/articles/PMC5703145/#!po=2.27273
Osteoporosis and RA: NIH Osteoporosis and Related Bone Diseases National Resource Center. (2018). “What People With Rheumatoid Arthritis Need To Know About Osteoporosis.” bones.nih.gov/health-info/bone/osteoporosis/conditions-behaviors/osteoporosis-ra
Obesity and RA: Current Rheumatology Reports. (2016); “The Obesity Epidemic and Consequences for Rheumatoid Arthritis Care.” ncbi.nlm.nih.gov/pmc/articles/PMC4809046/
Smoking and RA: Annals of the Rheumatic Diseases. (2010). “Impact of Smoking as a Risk Factor for Developing Rheumatoid Arthritis: A Meta-analysis of Observational Studies.” ard.bmj.com/content/69/01/70
Secondhand Smoke and RA: Rheumatology. (2018). “Passive Smoking in Childhood Increases the Risk of Developing Rheumatoid Arthritis.” ncbi.nlm.nih.gov/pubmed/30124939