Introduction
Rheumatoid arthritis is increasing day by day and is one of the factors associated with lifestyle. The main factors related to lifestyle affecting rheumatic disease are smoking, obesity, unhealthy diet, low socioeconomic status, low educational level, and poor physical activity. Patients with inflammatory rheumatic diseases (IRDs) frequently express a wish to modify lifestyle factors to either guarantee the efficacy of medical treatment or to partially substitute antirheumatic medicines. The abundance of media stories that discuss the impact of stress, physical fitness, body weight, and nutrition on health and life expectancy encourages this desire. Patients with rheumatic illnesses are also a target market for marketing efforts that promote foods with actual or presumed health benefits, as well as other commercial offers that guarantee better health, a longer lifespan, and a higher degree of well-being. The prevention of obesity, cessation of smoking, and maintenance of high levels of physical activity support the treatment of rheumatic disease. This article aims to describe the role of lifestyle factors in rheumatic disease.
What Is the Role of Lifestyle Factors in Rheumatic Diseases?
There is some evidence that a few factors of lifestyle affect patients with inflammatory rheumatic diseases (IRDs). The majority of the data in this regard are related to rheumatoid arthritis (RA), which amply demonstrates the significance of lifestyle in relation to the disease's risk. The effect of modifiable lifestyle factors (cigarette smoking, obesity, lack of physical exercise, bad food, and excessive alcohol consumption) on the risk of RA was recently examined in the Nurses Health Study (NHS) cohorts.
The following are the factors of lifestyle affecting rheumatic disease:
1. Nutritional Factors - The human food consists of various compounds. Its provenance, method of preparation, and quality are all somewhat erratic and change over time. Nonetheless, it is now widely known that food can affect the body's inflammatory environment through a number of different mechanisms. Our microbiome's composition is influenced by our dietary practices, and this is being increasingly acknowledged as a significant factor in the etiology of IRD. A high-fiber diet was associated with lower levels of inflammatory cytokines in a population without RA (rheumatic arthritis). In addition, the negative relationship between n-3 fatty acids and autoantibodies in people at high risk for RA suggests that polyunsaturated fatty acids may have immunomodulatory and anti-inflammatory properties. Nevertheless, substantial databases are required to validate the significance of these factors in relation to the risk of Inflammatory Rheumatic Diseases (IRD). Through the analysis of data from over 50,000 women, the study identified factors like low birthweight and inadequate childhood nutrition as contributors to Rheumatoid Arthritis (RA). These studies, encompassing over 150,000 women with 1,000 newly diagnosed RA cases, required participants to complete biennial food frequency questionnaires. The regular consumption of sugar-sweetened soda alone was associated with an increased risk of RA.
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Fish and Polyunsaturated Fatty Acids (PUFA) - The anti-inflammatory and anti-arteriosclerotic effects are seen in polyunsaturated oils (such as fish oils and various plant oils). Numerous investigations have noted a tendency suggesting a protective function of fish, particularly oily fish varieties, even though the observed outcomes did not reach statistical significance.
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Adiposity and the Risk For RA - Obesity had the most marked effect on RA risk. Women who gained more than 20 kilograms exhibited a relative risk (RR) of 3.8 for seropositive RA compared to those maintaining a stable weight. Consequently, this study effectively corroborates earlier findings suggesting a link between Body Mass Index (BMI) and RA risk, albeit with notable heterogeneity. Importantly, the joint presence of adiposity and smoking was disproportionately linked to the development of definite RA in a preselected cohort of individuals without arthritis but positive for RA-associated autoantibodies, compared to each component alone.
2. Alcohol - The low-to-moderate amounts of alcohol serve as a protective factor against Rheumatoid Arthritis (RA). Analysis of data from 30,447 individuals in the Malmö Diet and Cancer Study revealed that those with moderate baseline alcohol intake (3.5 to 15.2 g/day compared to < 3.5 g/day) showed a tendency toward a reduced risk of RA (odds ratio of 0.48) in contrast to participants consuming less than 3.5 g of alcohol daily. This study's findings were adjusted for smoking and education levels.
3. Smoking - The major environmental risk factor for developing rheumatoid arthritis is exposure to tobacco smoke. Smoking causes 20 % of all rheumatoid arthritis cases. The twin study of 1996 confirmed the relationship between smoking and the development of rheumatoid arthritis. However, smoking leads to lung disease, periodontitis (inflammation of the bone of the tooth), and other inflammatory diseases. The outcome of the treatment in smoker patients with rheumatoid arthritis is poor and has a poor prognosis. The cessation of smoking is favorable in preventing the progression of rheumatoid disease.
4. Socio-economic Status - The relationship between health and socioeconomic status is common, as high socioeconomic status leads to better health and vice-versa.
The following are the socio-economic factors associated with the development of rheumatoid arthritis:
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Smoking.
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Nutrition.
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Marital status.
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Lower education.
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Occupation.
5. Psychological Stress - Psychological stress develops chronic diseases, and it is a trigger factor for other disorders, too. Studies show that psychological stress affects the immune system and causes chronic diseases. Work stress, social stress, and emotional stress in patients with rheumatological diseases affect their prognosis. Some studies also show the influence of pain and illness in patients with rheumatological diseases due to psychological stress. However, there is limited research on the effect of stress on developing rheumatoid diseases. Limited decision-making freedom was notably linked to a higher likelihood of developing rheumatoid arthritis (RA), with an odds ratio of 1.6. Conversely, elevated psychological job demands exhibited a tendency toward a diminished risk of RA. These associations persisted even after accounting for adjustments related to social class.
6. Marital and Family Status - It is noticed that the person with rheumatoid arthritis is generally divorced. However, the progression of the disease is lower in married people. The patients who are living happy married life experience less pain and disabilities in rheumatoid disease. These things are comparable just because of one factor, and that is social support and security. Married people have social support as compared to unmarried people.
Conclusion
The development and progression of rheumatoid arthritis are influenced by environmental factors. Several of these environmental factors directly interact with underlying genetic predispositions. One example of such interaction is evident in the relationship between smoking and rheumatoid arthritis. Certain environmental aspects, including smoking, dietary choices, and physical activity, may be under the influence of the patient. Understanding how individual lifestyle components impact the onset or advancement of the disease empowers physicians to offer appropriate guidance to patients or those at risk. Determining the specific contribution of a singular factor to disease development is often challenging, as many risk factors tend to cluster together. This is particularly true for elements such as dietary habits, nicotine consumption, physical activity, and socioeconomic status, all of which are linked to educational background. Additionally, the onset of rheumatoid arthritis itself might alter the lifestyle and socioeconomic status of patients, and these reciprocal effects must be considered. Patients should also take care of their lifestyle so as to prevent the progression of rheumatoid diseases.
