The likelihood of developing RA appears to be greater in people who have a combination of risk factors, such as smokers with a family history of the disease, but many people with RA have none of these predisposing characteristics. To further complicate the issue, there is also evidence that infection with certain viruses and bacteria may trigger the disease in some individuals.
Because so many different factors may cause the immune system to malfunction and turn on itself, it’s impossible to predict who will develop RA.
“This makes it difficult to individualize or personalize recommendations [for prevention],” says Demoruelle, who is an assistant professor of medicine at the University of Colorado.
Demoruelle believes that studies looking at the earliest phases of the disease may be key to improving our understanding of RA and perhaps eventually developing reliable methods of predicting who will get it. For example, researchers have found that there is a preclinical phase of the disease in which biomarkers for RA, such as rheumatoid factor antibodies, are present in the blood years before symptoms appear and the disease is diagnosed.
A handful of preliminary clinical trials are investigating whether drug therapy during this preclinical phase can delay the development of RA or even prevent it altogether, but it’s too early to draw any conclusions.
“In the future it may be possible to use milder interventions to ‘reset’ the immune system before RA develops, but more research is needed,” says Demoruelle.
A growing body of evidence also indicates that it may be possible to decrease the odds of developing RA by making lifestyle changes to modify your risk factors.
“There is plenty of evidence that lifestyle affects the immune system,” says Dr. Leonard Calabrese, a rheumatologist and immunologist in clinical practice at the Cleveland Clinic in Ohio.
Unhealthy habits, such as a high-sugar diet, have been found to increase the incidence of RA. A study cited in the journal Nutrition & Diabetes found that young adults between the ages of 20 and 30 who drank five or more high-sugar beverages each week – including apple juice and sodas and fruit drinks sweetened with sugar or high fructose corn syrup – had three times the incidence of any arthritis than those who drank fewer, or no, sugary drinks.
In contrast, a healthy diet has been shown to decrease the risk of RA, according to Calabrese, who is also the Director of Clinical Immunology at the Cleveland Clinic Lerner College of Medicine. A study of people with a first-degree relative with RA found a lower incidence of the disease in individuals who followed a low-protein Mediterranean-type diet that includes plenty of vegetables, fruits and fats enriched with omega-3 fatty acids, as compared with those who ate less-healthy diets.
Stress also impacts overall immune system functioning. Stress causes the release of cytokines, molecules responsible for inflammation and pain in RA. And the more stressed you are, the more cytokines your body produces.
“Biobehavioral approaches, such as mindfulness meditation, have been proven to be very effective in combating stress,” says Calabrese, who recommends it to all of his patients with an autoimmune disease.