Test your medicine knowledge: Reducing the personal risk of developing rheumatoid arthritis

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 29-year-old woman is evaluated during a routine examination. She seeks advice in reducing her personal risk of developing rheumatoid arthritis, because her mother was recently diagnosed with the disorder. The patient is asymptomatic. She has a 10-pack-year history of smoking and consumes six alcoholic beverages per week, usually on weekends. She is sedentary and overweight. She takes oral contraceptives.

On physical examination, vital signs are normal. BMI is 29. There is no synovitis or bony abnormalities. The remainder of the examination is normal.

Which of the following lifestyle modifications is most likely to reduce the patient’s risk of developing rheumatoid arthritis?

A: Alcohol cessation
B: Discontinuation of oral contraceptives
C: Increased physical activity
D: Smoking cessation
E: Weight loss

MKSAP Answer and Critique

The correct answer is D: Smoking cessation.

Smoking is associated with an increased risk of developing rheumatoid arthritis, and cessation is recommended for this and other health reasons. Heritable factors convey susceptibility for developing rheumatoid arthritis. Environmental factors seem to modify this risk. Duration and intensity of smoking correlate with this risk. Users of smokeless tobacco do not have an increased risk of developing rheumatoid arthritis, suggesting it is not simply an effect of nicotine. Smoking cessation is associated with a decline in the risk of developing rheumatoid arthritis, although this benefit is not immediate.

Alcohol use is not associated with an increased risk of rheumatoid arthritis. The patient may be advised to moderate her consumption of alcohol, but it will not alter her risk of developing rheumatoid arthritis.

Hormonal factors may play a role. The risk of developing rheumatoid arthritis is higher in women, but lower in women who have had children. Breastfeeding is associated with a decreased risk of developing rheumatoid arthritis and may account for some or all of the protective effect of parity. The risk of rheumatoid arthritis is inversely associated with duration of lifetime breastfeeding. In one study, use of oral contraceptive pills for 7 or more years was associated with a decreased risk of rheumatoid arthritis. Discontinuing oral contraceptives in this patient may be associated with increased risk or no change in her risk but not a decreased risk.

Obesity and sedentary lifestyle are associated with a number of health risks but have not been clearly linked to the development of rheumatoid arthritis. In patients with rheumatoid arthritis, range of motion exercises help preserve joint motion; in patients with osteoarthritis, aerobic exercise helps maintain muscle strength, joint stability, and physical performance, and weight reduction reduces joint stress on weight-bearing joints.

Key Point

  • Smoking is associated with an increased risk of developing rheumatoid arthritis, and cessation is recommended for this and other health reasons.

This content is excerpted from MKSAP 16 with permission from the American College of Physicians (ACP). Use is restricted in the same manner as that defined in the MKSAP 16 Digital license agreement. This material should never be used as a substitute for clinical judgment and does not represent an official position of ACP. All content is licensed to KevinMD.com on an “AS IS” basis without any warranty of any nature. The publisher, ACP, shall not be liable for any damage or loss of any kind arising out of or resulting from use of content, regardless of whether such liability is based in tort, contract or otherwise.

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