Rheumatoid arthritis is somewhat of a medical mystery. Doctors believe that genetics influence the development of the disorder, but environmental factors, i.e. habits and activities within the patient’s control, may determine whether someone at risk does or does not develop RA.
First, let us look at the genetic component of RA. People with rheumatoid arthritis have been found to have antibodies in their systems called anti-citrullinated protein/peptide antibodies (ACPAs for short). These antibodies, which attack the patient’s own proteins, signal the presence of RA. ACPAs are the most reliable predictor of RA. Another genetic marker of RA risk is the “rheumatoid factor.” The rheumatoid factor is also an antibody that shows up in patient blood work, but it is present in only eighty percent of actual rheumatoid arthritis patients. Both the rheumatoid factor and ACPAs can be accurately assessed with a blood test.
Anyone with a close family member who has developed rheumatoid arthritis should assume that he or she is at risk unless a blood test has clearly shown the absence of ACPAs and the rheumatoid factor. However, it is important to note that not everyone with ACPAs will develop rheumatoid arthritis.
Age and gender play an important role. The incidence of RA in women is three times higher than it is in men. And, while RA does sometimes attack young people, it is much more likely to attack people over forty.
Whether someone who is at risk for rheumatoid arthritis actually develops the condition is, in some cases, a matter of lifestyle choices. The single most important thing a patient at risk for RA can do is to refrain from smoking or quit smoking. The risk of developing RA doubles for anyone at risk who has smoked a pack or more a day for forty years. Smoking actually increases the risk of developing ACPAs and rheumatoid factor markers. Unfortunately, heavy smokers can develop RA twenty years after they quit smoking, so the message is clear: smoking is dangerous to everyone and especially to people at risk for rheumatoid arthritis. Parents and family doctors should definitely counsel anyone at risk for RA to never begin smoking.
Other lifestyle factors such as weight can influence the development and severity of RA. Being overweight at any age increases the risk, with obese individuals at a substantially increased risk. Overweight babies are also at risk of developing RA as adults. One study shows that babies who weigh more than 9.9 pounds at birth are twice as likely to develop RA than their slimmer peers. This strongly suggests that pregnant women who are likely to pass on a genetic predisposition to rheumatoid arthritis should carefully monitor their weight gain to prevent having an overweight baby.
The widely dispersed advice to drink one glass of red wine a day may have definite applications to rheumatoid arthritis. Very moderate alcohol consumption has been shown to lower the chances of developing RA. It is important to note, however, that excessive consumption of alcohol comes with myriad health risks. By no means does this article advocate excessive drinking. The max amount of alcohol for someone at risk of developing RA is six or seven drinks a week. This is particularly important for women, who can develop liver cirrhosis on as few as two drinks a day, to exercise moderation in drinking and never exceed the recommended dose needed to inhibit rheumatoid arthritis.
Because women are at much greater risk for RA than men, it is worth noting that oral contraceptives may play a role in inhibiting the development of the condition. Several studies suggest that taking birth control pills may lower the chances of developing RA.
Babies who are breastfed for thirteen months or longer have greater immunity to a host of medical conditions and rheumatoid arthritis is among them. In other words, mothers who breastfeed for a year or more are doing their children a huge favor which those children may not cash in until middle age. And there is also some evidence that the longer a baby is breastfed, the more unlikely he is to develop RA. Pregnant women and new mothers whose children are at risk for RA should definitely consider extended breastfeeding.
Exposure to asbestos and silica can heighten the risk of RA. People at risk for exposure to these chemicals are those who work in the construction industry or manufacturing and also residents of low-income housing that has not been well maintained. Emergency aid workers who took part in the World Trade Center rescue effort are now known to be at risk for development of RA because they inhaled the dust of the collapsed buildings.
There is some evidence that people who do manual labor are at greater risk of developing RA. This probably has to do with the added stress on joints as well as possible exposure to toxic substances such as asbestos.
Another factor in the development of RA is where you live. One study shows that people who reside in the northeastern United States were forty-five percent more likely to develop RA than those who live in the western regions of the US. Because the northeast is more populous and, especially in the large urban areas, more costly, there is some evidence that stress may play a role in the development of RA, but further research must be done before any definite conclusions can be drawn.