Preventing Rheumatoid Arthritis

Rheumatoid arthritis (RA) is a chronic autoimmune condition in which the body attacks its own cells, causing pain and inflammation. While RA can affect a number of tissues and organs, including the heart, it primarily targets joints. The specific cause of RA has not been identified, but a number of risk factors and lifestyle choices may play a role.

Some of the known risk factors for RA include:

• Advancing age, with most cases beginning when a person is in their 60s
• Female sex, especially those who have never given birth
• Genetics, with a high association with human leukocyte antigen (HLA) class II genotypes
• Smoking
• People whose mothers smoked during pregnancy, or who were exposed to secondhand smoke early in life
• Low income
• Obesity

While there is no known way to prevent RA altogether, certain behaviors may help delay disease onset and minimize its impact on your quality of life.

Stop Smoking

Smoking and exposure to cigarette smoke is a major risk factor for RA. One study found that the risk of developing RA was approximately twice as high for smokers as it is for non-smokers.

Smoking can affect the immune system by increasing oxidative stress on the body, triggering inflammation, and promoting apoptosis (cell death). Quitting smoking and avoiding secondhand smoke might be helpful in preventing the development of RA.

The Centers for Disease Control and Prevention (CDC) offers a number of resources that can help if you want to quit smoking. These include live quitlines, medications, text messages, a free smartphone app, support groups, and help with making a quit plan.

To make a quit plan:

• Set a specific date to start
• Tell friends and family what you are trying to do so they can help keep you accountable
• Get rid of items and habits that remind you of smoking
• Develop new routines that help you avoid smoking triggers
• Keep a written list of reminders for why you want to quit
• Identify a support system
• Find ways to cope with cravings
• Identify rewards for when you reach milestones

Limit Alcohol

Alcohol doesn't have to be completely off the table for people with RA, but it's best to limit your intake. Long-term moderation in alcohol drinking has been linked to lower RA risk in women.

When you have RA, the main concern with alcohol is its potential interaction with medications you may be taking for treatment of the condition. Some medications used to treat RA, like methotrexate, can be damaging to the liver. Alcohol use, which can also hurt the liver, may increase that risk.

Talk to your healthcare provider about how much alcohol you can consume and be sure to find out whether any medications you are taking completely contraindicate drinking alcohol.

Minimize Bone Loss

RA is associated with bone loss and osteoporosis. Pain and joint stiffness caused by RA can lead to inactivity, increasing osteoporosis risk. And the glucocorticoid medications often prescribed for the treatment of RA can contribute to significant bone loss.

You can help prevent or slow down RA associated bone loss by:

• Making sure your diet is rich in calcium or vitamin D
• Taking supplements for bone health if these nutrients aren't part of your diet
• Getting guidance from your healthcare provider to avoid the progression of your RA
• Avoiding long term use of glucocorticoids

Improve Oral Health

Inflammation may contribute to the development of RA. To help prevent inflammation, keep your teeth and gums in good shape, and see your dentist regularly to prevent chronic oral health problems or infections.

A 2017 study at Johns Hopkins University found that some types of bacteria that cause gum disease, such as Aggregatibacter actinomycetemcomitans, release a toxin that triggers specific types of antibody production. These antibodies were found in 62% of people with chronic periodontitis and 43% of people with RA, suggesting that both conditions may be triggered by the same bacterial process.

Increase Fish Intake

Fish is rich in a number of nutrients, particularly omega-3 fatty acids and vitamins A and D. Eating fish regularly is a good idea for anyone, but fish oil has been shown to be especially helpful for people with inflammatory diseases and various types of arthritis, including RA.

Research suggests that eating fish several times each week may be protective against RA.

Maintain a Healthy Weight

A healthy diet can be beneficial when it comes to preventing RA. Obesity has been linked to the condition, and maintaining a healthy weight may reduce your risk of RA. Additionally, a number of vitamins and minerals—like vitamin D and calcium—can help keep RA and osteoporosis from progressing.

There is also some evidence that anti-inflammatory diets can help fight RA and other inflammatory diseases. These diets typically rely on elements of vegetarian, gluten-free, and Mediterranean diets.

While these diets don't have a significant effect on disease development or progression, eating or avoiding certain foods seems to help some patients with RA when combined with other therapies.

Key aspects of these diets include:

• Fish—mostly salmon—three to four times each week
• Vegetarian meals with legumes one to two times each week
• Potatoes
• Whole-grain cereals
• Low-fat dairy
• Five or more servings of fruit and vegetables each day
• Probiotics

Superfoods for an anti-inflammatory diet include:

• Tomatoes
• Olive oil
• Spinach
• Kale
• Almonds
• Walnuts
• Salmon
• Tuna
• Strawberries
• Blueberries
• Cherries
• Oranges

Foods best avoided or limited include:

• No more than three servings of meat per week
• Processed meats
• Red meats
• Margarine
• Lard
• Shortening
• Refined carbohydrates, like white bread
• Fried foods
• Sodas

Stay Active

Regular exercise—even low-impact exercise—can help with chronic disease prevention. Exercise improves bone health, heart health, mental health, and more.

All types of exercise—aerobic, weight training, stretching, and yoga—can also be protective against diseases like RA and may help slow progression and relieve symptoms of the disease. Yoga, in particular, can reduce pain, inflammation, and stress and improve mental health, balance, and strength.

Some of the best examples of exercises for people with RA include:

• Stretching
• Walking
• Yoga and Tai Chi
• Aquatic exercise
• Biking
• Strength training

When you have RA, it's important to listen to your body. Be mindful of pain, and don't push yourself to discomfort.

The right equipment, like supportive shoes, can help you stay safe and get the greatest benefit from your efforts.

Reduce Exposure to Environmental Pollutants

Environmental pollutants like chemicals used in cleaning and manufacturing have been shown to trigger a host of health problems—especially in people with certain genes.

The HLA gene has been tied to the development of RA, and studies have found that pollutants like dioxin and cigarette smoke are associated with disease development in people with this gene. New medications are being investigated to block these actions, but avoidance of harmful chemicals is best when possible.

Take Early Action

RA is a chronic, progressive disease that can lead to disabling joint damage. Early symptoms can include morning stiffness that resolves in about an hour.

If you think you have RA or are at risk of developing the condition, talk with your healthcare provider. Early and aggressive treatment with medications that help stop inflammation is key to preventing severe joint damage or damage to other organs.