One of the questions that people often have regarding autoimmune conditions, including rheumatoid arthritis (RA), is, "What can I do to prevent it?" The truth is, while experts are learning more every day about the causes of RA (genetics, environment, and infection all seem to play roles), we still don't know exactly what pushes one person to get the disease while someone else does not. Which means there's no smoking gun to prevent it.
Some good news, though: You can do plenty to reduce your risk of developing RA. And the same strategies that lower your odds of getting it can also help you manage and minimize symptoms, even if you do develop RA down the line. Take a look at what experts and research suggest you can control when it comes to RA.
With all the advances in medicine, you might wonder if there's a drug you can take preventatively for RA. Answer: No. "It's possible to reduce the risk of developing RA, but it's not possible to fully prevent it with medication at this point," says Anna Helena Jonsson, M.D., Ph.D., assistant professor of medicine-rheumatology at the University of Colorado School of Medicine in Aurora, CO. RA is a complex disease that involves the intricate immune system. "We don't know how to inhibit the root cause," Dr. Jonsson says, explaining that's because researchers haven't yet identified a single root cause.
A drug that prevents RA may one day be available, though. Researchers are working to find a treatment that could potentially stop at-risk people from developing the disease, says Jeffrey Sparks, M.D., assistant professor of medicine and associate physician at Brigham and Women's Hospital and Harvard Medical School in Boston. "There were two really exciting trials last year that enrolled people who were on the cusp of developing RA -- they had positive antibodies and sometimes had symptoms but no overt [joint] swelling. Some had imaging findings consistent with RA," Dr. Sparks says. "These people who were at a high risk of developing RA in the near future were randomized to take either a medication called abatacept (Orencia), or a placebo." The medication appeared to prevent RA in several study participants.
This serves as proof of principle, Dr. Sparks notes, that RA can be prevented or at least delayed if doctors identify high-risk people at the right time. More studies must be done before this taking abatacept could become a clinical recommendation. "The drug is approved for RA but typically as a third-line treatment, so this might provide some rationale to move it up in the treatment line," Dr. Sparks adds.
In the meantime, though, no single drug is credited with preventing RA, so instead, the focus is on lowering risk of the disease as well as minimizing RA's symptoms and severity if you've already been diagnosed.
While there's no surefire way to prevent RA, four core lifestyle changes can help you minimize your risk. These moves aren't just good for RA prevention -- they'll improve your health overall, too.
Quit Smoking
"Stopping smoking can reduce your risk of getting RA," Dr. Jonsson says. Tobacco increases your risk for developing RA and worsens flares if you do have the condition. "RA is thought to develop in mucosal tissues, which are in the mouth, airway, and gut -- places where the inside of the body is in contact with the outside world," Dr. Jonsson explains. "Smokers inhale lots of toxins, and those cause inflammation in the lungs, and that causes molecular changes that play a role in RA."
We don't know why this form of inflammation is correlated with an autoimmune disease that primarily affects the joints, she adds, but there's clearly a connection. (This could also be why people with RA are at an increased risk of developing interstitial lung disease.) Inhalants of any kind that irritate the lungs could put you at risk, Dr. Sparks says, so it's best to avoid smoking anything, including cigars or marijuana.
Maintain a Healthy Weight
RA is related to inflammation and autoimmunity, "so anything in the body that increases inflammation can put you at risk for RA or another autoimmune disease," Dr. Sparks says. Obesity is known as a chronic inflammatory state, he adds, so maintaining a healthy weight can help reduce overall inflammation and support healthy immune function.
The reason obesity causes inflammation isn't totally clear. One theory is that adipose (fat) tissue is more inflammatory (causing inflammation in the body), notes Dr. Jonsson, "so people who are obese have baseline inflammation that's a little higher and that can set fire to RA." Research in mice has also found that memory T-cells, immune cells that respond and activate rapidly when they detect a "threat" they've seen before, like to live in fat tissue, Dr. Jonsson says. "[Fat] provides a pro-inflammatory home for them to hang out in, whereas if you're at a healthier weight, you don't have that spot where these T-cells like to stay," she explains.
Take Care of Oral Health
"Gum disease is highly linked to developing RA," says Dr. Jonsson, so tending to your dental health by flossing and brushing your teeth can help reduce risk. Similarly to smoking, inflammation in the gums leads to certain cellular changes that are tied to RA, Dr. Jonsson explains. Research backs her up. One study in Science Translational Medicine that looked at the links between RA and periodontal (gum) disease pinpointed a specific periodontal bacteria -- Aggregatibacter actinomycetemcomitans (Aa) -- that triggered what's known as hypercitrullination, a process that causes an abnormal accumulation of citrullinated proteins (proteins altered by an enzyme). This same biological process of excessive citrullination is also at the root of RA inflammation in the joints.
Reduce Exposure to Pollutants
Experts believe that environmental factors play a role in RA development -- one of which seems to be exposure to air pollutants. According to a review on the connection between pollutants and the development of RA in Environmental Pollution, air pollutants (a mixture of gasses and particles produced by traffic, industry, agriculture, smoking, and natural sources) play a significant role in the development and exacerbation of RA thanks to how they activate inflammatory pathways and increase inflammatory cells in the body.
Per the Arthritis Foundation, a few pollutants clearly associated with RA are second-hand smoke, asbestos, silica dust, and pesticides. While it's impossible to avoid all harmful chemicals in the environment, doing what you can to reduce your exposure to these big ones can help mitigate your risk -- that means using personal protective equipment (PPE) if you work in construction or a manufacturing job where you're exposed to particulate and chemicals, avoiding second-hand smoke, and forgoing pesticides and other chemicals as best as you can in your own home and yard.
If you do develop RA, you can take several steps to reduce the impact of the disease. First and foremost, you want to see a doctor and start on RA treatment ASAP, says Dr. Jonsson. "We know that the quicker you get joint swelling controlled, the better the long-term outcome will be," she says. Simultaneously, focusing on a few lifestyle habits can help you manage symptoms and be your healthiest self with RA. "Lifestyle does seem to impact flares and disease activity," says Dr. Sparks. Here are a few things you can do.
Exercise
"Physical activity can definitely help," says Dr. Sparks. "We tell people to be as physically active as possible," he adds. If you have limitations or activities that cause you pain, your doctor can refer you to a physical therapist to help determine what movements feel good for you. Exercise helps for multiple reasons: It reduces inflammation, keeps the joints fluid and prevents stiffness, and helps you maintain a healthy weight, according to Dr. Jonsson. It's also essential for cardiovascular health -- which is even more important since people with RA have an elevated risk of heart disease, she adds. Finally, stronger muscles take pressure off the joints and cartilage, which can be a gamechanger, especially if you have any wear-and-tear arthritis on top of your RA.
Follow a Healthy Diet
"A lot of people ask about diet, and there's no specific diet for RA that makes a big difference," says Dr. Jonsson. "We recommend a healthy, Mediterranean-style diet, which we recommend to everybody," she says. That means eating healthy foods like fruits, vegetables, beans, legumes, seeds, olive oil, lean protein, and fish, and avoiding inflammatory foods like sugar, red meat, and other processed foods. "There's some data that suggests omega-3 and vitamin D may be helpful as well," Dr. Sparks says.
A research review in the Mediterranean Journal of Rheumatology on omega-3 fatty acids and RA found that the lipids have anti-inflammatory actions and may help regulate autoimmunity and improve symptoms of RA. Though much of the research has been on mice, these healthy fats are also known to be excellent for heart health, so eating foods rich in omega-3s -- like fatty fish, avocados, walnuts, chia seeds, and flaxseed -- will benefit you in more ways than one.
The vitamin D connection is still up for debate. Research shows that vitamin D deficiency is more common in people with RA, but whether lack of this vitamin contributes to the development of RA or is simply a result of the disease is unclear. The authors of one study on RA and vitamin D in BMC Rheumatology concluded that there's no cut-and-dry evidence showing low D causes RA to develop or worsen, and more studies are needed to define the relationship between the vitamin and the autoimmune disease.
Reduce Sugar and Salt Intake
According to research on dietary intake and RA in the journal Nutrients, people with RA should limit sodium and sugar intake. Both high dietary sodium intake and consumption of sugary drinks (like soda) have been associated with an increased risk of RA, according to the Nutrients study, due to how they affect proteins in the body and support inflammation. Salt may be even more detrimental when combined with smoking, as the two may enhance each other's effects on key inflammatory markers in the body, though researchers note more studies need to be done to reveal this connection.
Cut Back on Alcohol
Interestingly, moderate alcohol consumption seems to lower RA disease activity, according to a research review on the effect of alcohol on RA disease activity and outcomes in Scientific Reports. However, alcohol does not play well with many of the medications used to treat RA. In particular, drinking while taking non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Motrin) and naproxen (Aleve) increases your risk of stomach bleeding and ulcers, per the Arthritis Foundation. When paired with acetaminophen, methotrexate or leflunomide (Arava), alcohol can make you more susceptible to liver damage. So, the best way to improve symptoms and feel better with RA is to cut back on drinking so that your meds can work the way they should without causing unwanted side effects.
One day in the future, there may be a way to identify people with the highest likelihood of developing rheumatoid arthritis and proactively treating them to prevent the condition from ever emerging. Until then, though, there are a handful of valuable ways to lower your risk of RA, and to improve symptoms even if you do develop the disease. If you have concerns, talk with your doctor about ways to reduce your risk today.