The Relationship Between Unhealthy Lifestyle Factors and Rheumatoid Arthritis


While lifestyle habits are modifiable risk factors, changing them can be especially challenging for patients with rheumatoid arthritis, who must also deal with chronic inflammatory disease.

Many patients with rheumatoid arthritis (RA) had 2 ore more unhealthy lifestyle factors, thus implying a complex relationship between these factors and disease impact, according to a study published in Springer.1

“It is important to remember that lifestyle habits are modifiable risk factors,” stated investigators. “However, changing them is known to be a challenge for everyone, potentially affecting quality of life. The higher the number of unhealthy lifestyle habits, the bigger the challenge, according to people living with RA, who must also deal with the symptoms of living with a chronic inflammatory disease.”

In this cross-sectional study, participants from 2 Scandinavian countries, Denmark (n = 289) and Sweden (n = 955), were analyzed to determine the impact unhealthy lifestyle factors had on disease impact. Investigators focused on smoking, body mass index (BMI), physical activity, and alcohol intake and were classified as healthy vs unhealthy. Swedish participant data was taken from the Better Anti-Rheumatic Pharmacotherapy (BARFOT) and Danish data was retrieved from the Danish Hospital for Rheumatic Diseases. Both countries treat patients with RA based on the European Alliance of Associations for Rheumatology (EULAR).

Healthy physical activity was defined as at least 150 minutes of exercise per week. Alcohol intake was analyzed based on being either above or below each country’s recommended limit. Smoking habits were based on tobacco use or the absence of it. Disease activity was determined by the Health Assessment Questionnaire (HAQ), EurolQol-5 Dimensions (EQ-5D), the visual analogue scale (VAS) in Denmark, and the numeric rating scale (NRS) in Sweden.

In the Danish cohort, 95% of participants self-reported at least 1 unhealthy lifestyle factor, and 66% had 2 or more, compared with 82% and 47%, respectively, in Swedish participants. The most common factors were a lack of physical activity and being overweight or obese. In the Danish group, 63% were overweight or obese and 84% did not achieve the recommended physical activity, compared with 54% and 52%, respectively, in the Swedish cohort.

In both cohorts, the women were both significantly younger and reported worse fatigue and function compared with the men. Similarly, men in both cohorts were linked to an increased risk of exhibiting 2 or more unhealthy lifestyle factors (Denmark: OR 1.86, 95% CI 1.21–2.85; and Sweden: OR 1.42, 95% CI 1.07–1.89). In the Danish cohort, cardiovascular disease (CVD) (OR 1.90, 95% CI 1.28–2.82) and disease duration (OR 0.97, 95% CI 0.95–0.99) were associated with 2 or more unhealthy lifestyle choices. In the Swedish cohort, participants with 2 or more unhealthy lifestyle factors were linked to worse HRQoL (EQ5D-3L, p = 0.001) and worse physical function (p < 0.001) when compared with those with no unhealthy factors.

Well-defined groups, with a broad perspective on lifestyle factors, strengthened the study. However, the small sample size both limited the number of patients that could be classified as having none or all 4 habits and may have affected generalizability. However, patients with rheumatoid arthritis are historically more likely to be overweight or obese and less physically active when compared with the general population. Additionally, while BMI was the factor that classified patients as healthy or unhealthy, rheumatoid arthritis increases the likelihood of cachexia, which could lead to misclassification of some patients. Lastly, the self-reported nature of the data may have led to some inaccuracy.

“In addition to the burden of living with long-standing disease, a large proportion of the patients in our two RA cohorts reported more than one unhealthy, but modifiable lifestyle factor of importance for the risk for CVD,” investigators concluded. “Our study supports that health professionals in rheumatology need to support healthy lifestyle changes in patients with RA and with a special focus on men and physical activity and dietary interventions.”


Karstensen JK, Primdahl J, Andersson MLE, Christensen JR, Bremander A. Lifestyle factors in patients with rheumatoid arthritis-a cross-sectional study on two Scandinavian cohorts [published online ahead of print, 2021 Sep 9]. Clin Rheumatol. 2021;10.1007/s10067-021-05905-2. doi:10.1007/s10067-021-05905-2

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