Challenges and Opportunities of Targeted Behavioral Interventions for Groups at Risk for Developing Rheumatoid Arthritis

Abstract

Background: Rheumatoid arthritis (RA) is a serious autoimmune disease which causes painful, swollen joints and can impact quality of life and increase morbidity and mortality. There are several preclinical stages of RA that correspond to at-risk groups that include: genetic risk, risk from behaviors, elevation of RA-related autoantibodies, and early clinical disease manifestations such as undifferentiated arthritis. Early interventions are crucial to slowing progression to and potentially preventing RA onset. Modification of behaviors among at-risk individuals may decrease RA risk. There are several challenges and opportunities in implementing preventative behavioral interventions, which may vary within different at-risk groups. Methods: We performed a narrative review of the literature, including meta-analyses focused on RA risk-related behaviors as well as publications investigating the potential efficacy of behavioral modifications on RA risk. Results: There are multiple behavioral risk factors associated with RA, including smoking, obesity, low physical activity, low quality diet, and poor dental hygiene, which may contribute to progression to clinical RA. Meta-analyses have been performed for smoking, excess body weight, and physical activity. Likelihood of adopting behavioral modifications may increase as RA risk increases. Conclusions: Clinicians may be able to tailor preventative approaches to various RA at-risk groups to help reduce RA risk, but further research is needed. A better understanding of the relationship of behaviors with RA risk and optimized approaches to implementing behavioral changes may allow for clinicians to tailor their preventative approaches for at-risk individuals.

Low-Intensity Physical Exercise Decreases Inflammation and Joint Damage in the Preclinical Phase of a Rheumatoid Arthritis Murine Model

“…The beneficial effects of PA and physical exercise (PE) on the clinical, metabolic, and cardiorespiratory features in patients with established RA have been widely documented [ 9 ]; indeed, PA is considered part of the comprehensive management of patients [ 10 , 11 ]. Nevertheless, studies evaluating the effects on the risk of developing RA are scarce, and evidence from observational studies is not entirely consistent [ 12 , 13 ]. Furthermore, the heterogeneity of the designs of the studies evaluating PE in RA, aside from the high risk of bias, precludes conclusive results; therefore, further research is still necessary [ 14 ].…”

A Roadmap for Investigating Preclinical Autoimmunity Using Patient-Oriented and Epidemiologic Study Designs: Example of Rheumatoid Arthritis

“…These correspond to genetic, lifestyle, autoimmunity, and early signs/symptoms ( Figure 1 ). Some of these phases may be amenable to behavioral ( 4 ) or pharmacologic interventions to delay or even prevent the onset of RA.…”