Table of ContentsView AllTable of ContentsFixed Risk FactorsLifestyle Risk FactorsNext in Rheumatoid Arthritis GuideHow Rheumatoid Arthritis Is Diagnosed
Table of ContentsView All
View All
Table of Contents
Fixed Risk Factors
Lifestyle Risk Factors
Next in Rheumatoid Arthritis Guide
RA is anautoimmune disease, which means that your immune system goes awry and attacks the tissues in your joints. The attack causes inflammation, which is the source of RA symptoms like pain, swelling, and joint stiffness. If you have risk factors for RA or any symptoms (they typically begin in fingers and other small joints), consult with your healthcare provider. Early treatment slows or stops progressive joint damage.
© Verywell, 2018
Non-Modifiable Risk Factors
Rheumatoid arthritisaffects some groups of people more than others. These groups define the non-modifiable risk factors of age, gender, andgenetics.
Age
While rheumatoid arthritis can strike at any age, the onset ofsymptomsusually begins between the ages of 30 and 50.Moreover, the risk increases as you get older. Aging weakens the immune system, making you more vulnerable to autoimmune disease.
Gender
Women are two to three times more likely to get rheumatoid arthritis than men.While the explanation for this disparity is far from definitive, hormones are believed to play a role. Research shows that women often develop RA after major shifts in their hormones, especiallyestrogen.
However, estrogen’s role is complex, and the exact relationship of hormonal fluctuations with RA has yet to be identified. For example, menopause (the loss of estrogen) is associated with a higher risk. At the same time, hormone replacement therapy (to restore estrogen) also increases your risk of RA.
Taking acombination oral contraceptive(birth control pills) may have a protective effect. According to researchers at the Karolinska Institute in Stockholm, women who used an estrogen-containing contraceptive for longer than seven years had a nearly 20% decreased risk of the most common type of rheumatoid arthritis compared to women who never took the pill.
Genetics
If you have a parent or sibling with rheumatoid arthritis, your risk of developing the disease is three to five times greater than the general population.According to a 2017 study inBest Practice& Research: Clinical Rheumatology, between 40%-50% of your risk of developing rheumatoid arthritis is genetic.
While the exact genetic permutations have yet to be identified, people with autoimmune diseases are believed to have one or more genetic deviations that alter the way their immune system recognizes and targets disease-causing agents.
Genes That May Play a RoleVariants in the human leukocyte antigen (HLA) system, which controls the immune response, are believed to be at the center of RA. Variations in other genes may also contribute, including:STAT4, a gene that plays an important role in the regulation and activation of the immune responseTRAF1 and C5, two genes associated with chronic inflammationPTPN22, a gene associated with both the development and progression of rheumatoid arthritis
Genes That May Play a Role
Variants in the human leukocyte antigen (HLA) system, which controls the immune response, are believed to be at the center of RA. Variations in other genes may also contribute, including:STAT4, a gene that plays an important role in the regulation and activation of the immune responseTRAF1 and C5, two genes associated with chronic inflammationPTPN22, a gene associated with both the development and progression of rheumatoid arthritis
Variants in the human leukocyte antigen (HLA) system, which controls the immune response, are believed to be at the center of RA. Variations in other genes may also contribute, including:
Smoking
Smoking has a cause-and-effect relationship with rheumatoid arthritis. Not only do cigarettes increase your risk of getting the disease, but they can accelerate the progression of your symptoms, sometimes severely.
A comprehensive review of clinical studies published in 2020 inCellsfound that people who smoked the equivalent of one to 10 packs yearly were 26% more likely to have RA. The risk increases to 94% in those smoking 20 packs yearly.The risk is greatly amplified if you also have the HLA marker.
As its own independent risk factor, smoking is known to promote cell death, increase inflammation, and stimulate the production offree radicalsthat further damage already inflamed joint tissue.
If you take medications totreat rheumatoid arthritis, smoking can interfere with their activity and make them less effective.This includes such foundational medications as methotrexate and newer TNF-blockers like Enbrel (etanercept) and Humira (adalimumab).
Obesity
Obesitycan trigger systemic inflammation, as excessive adipose (fat) cells lead to the increased production of inflammatory proteins known ascytokines.The more adipose cells you have in your body, the higher the concentration of certain cytokines.
Obesity can rob you of your ability to achieve remission, which is a state of low disease activity in which inflammation is under control. According to research from Weill Cornell Medical College, people with abody mass index (BMI)of over 30—the clinical definition of obesity, despite its limitations—are 47% less likely to achieve remission compared to people with a BMI under 25.
BMI is a dated, flawed measure. It does not take into account factors such asbody composition, ethnicity, sex, race, and age. Even though it is a biased measure, BMI is still widely used in the medical community because it’s an inexpensive and quick way to analyze a person’s potential health status and outcomes.
Infections
Though infections are associated with a higher risk of RA, more research is needed to verify their role. There may be cross-reactivity between antibodies (proteins produced to neutralize harmful invaders).As a result, antibodies that should only fight a specific virus or bacteria might also target your joints.
Infections that contribute to RA include theEpstein-Barr virus(EBV),hepatitis C virus(HCV), andEscherichia coli(E. coli).
Mental Health Conditions
Mental health conditions are risk factors for RA, and people diagnosed with RA also have a higher risk for PTSD and depression. They’re more likely to struggle with their mental well-being due to the stress of living with joint pain and a debilitating disease.
Toxins
Exposure to environmental toxins can activate the immune system, cause inflammation, and increase your risk of developing RA.Examples of environmental toxins include:
Organic dust comes from substances like hay and grains, and animal particles like hair, feathers, and wastes.
Periodontitis
Periodontitis is an advanced gum infection that can lead to significant inflammation, bone erosion, and tooth loss. Bacteria found in periodontitis are also associated with rheumatoid arthritis. Studies currently point to a direct relationship between these two conditions.However, more research is needed to determine the exact connection.
Lung Disease
RA-ILD alone occurs in up to 10% of people with RA.However, 60-80% of people with RA develop some type of lung disease.
The process may also work in reverse, with lung disease contributing to RA. Current research supports the concept that inflammatory lung disease raises your risk of RA.Some studies suggest that lung disease may be a primary cause of RA.However, the research is limited and more studies are needed to verify the connection.
Gut Imbalance (Dysbiosis)
The beneficial microorganisms in your gut (the microbiome) have a direct connection with your immune system. If your gut microbes become imbalanced, intestinal inflammation develops. That inflammation then spreads to trigger autoimmune diseases like rheumatoid arthritis.
Though the exact connection needs to be determined through future studies, medical experts know that people with RA have different proportions and a limited diversity of gut microorganisms compared to those who don’t have arthritis.
Summary
Rheumatoid arthritis has two types of risk factors: modifiable and non-modifiable. Non-modifiable risks (those you can’t change) include age, gender, and genetics. While you can’t alter your genes, lifestyle factors can affect their activity.
Lifestyle risk factors that are modifiable include smoking, obesity, exposure to environmental toxins, mental health conditions, periodontitis, and gut imbalances.
21 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Johns Hopkins Medicine.Rheumatoid arthritis.
National Library of Medicine: MedlinePlus.Aging changes in immunity.
Centers for Disease Control and Prevention.Rheumatoid arthritis.
Alpizar-Rodriquez D, Pluchino N, Canny G, et al.The role of female hormonal factors in the development of rheumatoid arthritis.Rheumatology.2017; 56(8):1254-63. doi:10.1093/rheumatology/kew318
Orellana C, Saevarsdottir S, Klareskog L, et al.Oral contraceptives, breastfeeding and the risk of developing rheumatoid arthritis: results from the Swedish EIRA study.Annal Rheumatic Dis.2017; 76:1845-52. doi:10.1136/annrheumdis-2017-211620
Deane KD, Demoruelle MK, Kelmenson LB, et al.Genetic and environmental risk factors for rheumatoid arthritis.Best Pract Res Clin Rheumatol. 2017 Feb;31(1):3-18. doi:10.1016/j.berh.2017.08.003.
Nemtsova MV, Zaletaev DV, Bure IV, et al.Epigenetic Changes in the Pathogenesis of Rheumatoid Arthritis.Front Genet. 2019 Jun 14;10:570. doi:10.3389/fgene.2019.00570.
Chang K, Yang SM, Kim SH, Han KH, Park SJ, Shin JI.Smoking and rheumatoid arthritis.Int J Mol Sci. 2014;15(12):22279-95. doi:10.3390/ijms151222279
Ishikawa Y, Terao C.The Impact of Cigarette Smoking on Risk of Rheumatoid Arthritis: A Narrative Review.Cells. 2020 Feb 19;9(2):475. doi:10.3390/cells9020475.
Sugiyama D, Nishimura K, Tamaki K, et al.Impact of smoking as a risk factor for developing rheumatoid arthritis: a meta-analysis of observational studies.Annals Rheum Dis.2010; 69(1):70-81. doi:10.1136/ard.2008.096487
Daïen CI, Sellam J.Obesity and inflammatory arthritis: impact on occurrence, disease characteristics and therapeutic response.RMD Open. 2015;1(1):e000012. doi:10.1136/rmdopen-2014-000012
Schulman E, Bartlett S, Schieir O, et al.Overweight and obesity reduce the likelihood of achieving sustained remission in early rheumatoid arthritis: Results from the Canadian early arthritis cohort study.Arthritis Care Res.2017. doi:10.1002/acr.23457
Arthritis Foundation.11 risk factors for rheumatoid arthritis and what you can do about them.
Kudaeva FM, Speechley MR, Pope JE.A systematic review of viral exposures as a risk for rheumatoid arthritis.Semin Arthritis Rheum. 2019 Feb;48(4):587-596. doi:10.1016/j.semarthrit.2018.03.011.
Romão VC, Fonseca JE.Etiology and Risk Factors for Rheumatoid Arthritis: A State-of-the-Art Review.Front Med (Lausanne). 2021 Nov 26;8:689698. doi:10.3389/fmed.2021.689698.
de Molon RS, Rossa C Jr, Thurlings RM, et al.Linkage of Periodontitis and Rheumatoid Arthritis: Current Evidence and PotentialBiological Interactions.Int J Mol Sci. 2019 Sep 13;20(18):4541. doi:10.3390/ijms20184541.
Bendstrup E, Møller J, Kronborg-White S, et al.Interstitial Lung Disease in Rheumatoid Arthritis Remains a Challenge for Clinicians.J Clin Med. 2019 Nov 21;8(12):2038. doi:10.3390/jcm8122038.
Demoruelle MK, Solomon JJ, Fischer A, et al.The lung may play a role in the pathogenesis of rheumatoid arthritis.Int J Clin Rheumtol. 2014;9(3):295-309. doi: 10.2217/ijr.14.23.
Dinache G, Popescu CC, Mogoșan C, et al.Lung Damage in Rheumatoid Arthritis-A Retrospective Study.Int J Mol Sci. 2022 Dec 20;24(1):28. doi:10.3390/ijms24010028.
Tsetseri MN, Silman AJ, Keene DJ, et al.The role of the microbiome in rheumatoid arthritis: a review.Rheumatol Adv Pract. 2023 Apr 3;7(2):rkad034. doi:10.1093/rap/rkad034.
Meet Our Medical Expert Board
Share Feedback
Was this page helpful?Thanks for your feedback!What is your feedback?OtherHelpfulReport an ErrorSubmit
Was this page helpful?
Thanks for your feedback!
What is your feedback?OtherHelpfulReport an ErrorSubmit
What is your feedback?
