PHYSICAL ACTIVITY BEFORE DISEASE ONSET AND ITS IMPACT ON THE RISK AND CLINICAL SEVERITY OF RHEUMATOID ARTHRITIS – A NARRATIVE LITERATURE REVIEW
Abstract
Background: Rheumatoid arthritis (RA) is a chronic, systemic connective tissue disease of immunological origin and unknown etiology, characterized by nonspecific symmetric joint inflammation, extra-articular manifestations, and systemic symptoms, ultimately leading to progressive joint destruction, disability, and premature death. The disease can be classified as seropositive or seronegative depending on the presence or absence of autoantibodies in the serum, such as IgM rheumatoid factor and/or anti-citrullinated peptide antibodies (ACPA) [1]. Increasing evidence suggests that environmental factors, including lifestyle and physical activity (PA), may influence both the risk of developing RA and the clinical course of the disease [2–4].
Aim: Assessment of the impact of physical activity undertaken prior to disease onset on the risk of developing rheumatoid arthritis and on the severity of symptoms at diagnosis.
Objective: To review the literature on whether PA prior to RA onset affects disease risk and severity at diagnosis.
Material and methods: A literature review was conducted using the PubMed, Scopus, and Web of Science databases, covering the years 2000–2025, with the following keywords:”Rheumatoid Arthritis, ”“Physical Activity, ”“Risk, ”“Disease Severity.” The review included cohort studies, cross-sectional studies, meta-analyses, and systematic reviews.
Results: A higher level of recreational physical activity during leisure time prior to disease onset is associated with a 20–35% reduction in the risk of developing RA [5–7], as well as with a milder disease course at diagnosis [8]. In contrast, high levels of occupational physical activity increase the risk of RA [9]. The protective mechanisms against disease development include modulation of the immune response, reduction of systemic inflammation, and improvement of metabolic profile [10–12].
Conclusions: Regular recreational physical activity may represent an important component of primary prevention of rheumatoid arthritis. Further prospective studies with objective measurements of physical activity are warranted.
References
Smolen JS, Aletaha D, McInnes IB. Rheumatoid arthritis. Lancet. 2016;388(10055):2023-2038. doi:10.1016/S0140-6736(16)30173-8
Sparks JA. Rheumatoid Arthritis. Ann Intern Med. 2019;170(1):ITC1-ITC16. doi:10.7326/AITC201901010
Scott DL, Wolfe F, Huizinga TW. Rheumatoid arthritis. Lancet. 2010;376(9746):1094-1108. doi:10.1016/S0140-6736(10)60826-4
Lee HS, Irigoyen P, Kern M, Lee A, et al. Interaction between smoking, the shared epitope, and anti–cyclic citrullinated peptide: A population-based case-control study. Arthritis Rheum. 2007;56(6):1745-1753. doi:10.1002/art.22697
Liu X, Tedeschi SK, Barbhaiya M, et al. Prospective study of physical activity and risk of developing rheumatoid arthritis in women. Arthritis Care Res (Hoboken). 2019;71(1):146-154. doi:10.1002/acr.23598
Di Giuseppe D, Bottai M, Askling J, Wolk A. Physical activity and risk of rheumatoid arthritis in women: a population-based prospective study. Arthritis Res Ther. 2015;17:40. doi:10.1186/s13075-015-0543-6
Ye J, Ye C, Huang Y, et al. Physical activity and the risk of rheumatoid arthritis: A systematic review and meta-analysis. Semin Arthritis Rheum. 2022;54:152042. doi:10.1016/j.semarthrit.2022.15204
Sandberg ME, Wedrén S, Klareskog L, Lundberg IE, Opava CH, Alfredsson L, et al. Patients with regular physical activity before onset of rheumatoid arthritis present with milder disease. Ann Rheum Dis. 2014;73(8):1541–4. doi:10.1136/annrheumdis-2013-204929
Kronzer VL, Crowson CS, Sparks JA, et al. Occupational physical activity and risk of rheumatoid arthritis: a population-based case-control study. Arthritis Care Res (Hoboken). 2022;74(4):607-615. doi:10.1002/acr.24592
Petersen AMW, Pedersen BK. The anti-inflammatory effect of exercise. J Appl Physiol. 2005;98(4):1154-1162. doi:10.1152/japplphysiol.00164.2004
Gleeson M, Bishop NC, Stensel DJ, et al. The anti-inflammatory effects of exercise: mechanisms and implications for the prevention and treatment of disease. Nat Rev Immunol. 2011;11(9):607-615. doi:10.1038/nri3041
Handzlik MK, Shaw AJ, Dungey M, et al. The Th17/Treg balance in health and disease: influence of exercise. Brain Behav Immun. 2021;94:1-10. doi:10.1016/j.bbi.2020.12.010
Uhlig T, Hagen KB, Kvien TK. Current exercise guidelines for people with arthritis. Curr Opin Rheumatol. 2019;31(3):307-314. doi:10.1097/BOR.0000000000000595
Gómez-Cabrera MC, Viña J, Ji LL. Exercise as an antioxidant: it up-regulates important enzymes for cell adaptations to exercise. Sci Sports. 2009;24(4):187-193. doi:10.1016/j.scispo.2009.03.002
Lemmey AB, Marcora SM, Chester K, et al. Effects of high-intensity resistance training in patients with rheumatoid arthritis: A randomized controlled trial. Arthritis Rheum. 2009;61(12):1726-1734. doi:10.1002/art.24881
Mankia K, Siddle HJ, Kerschbaumer A, et al. Physical activity in individuals at risk of rheumatoid arthritis: relationship to inflammation and joint symptoms. Ann Rheum Dis. 2019;78(12):1505-1510. doi:10.1136/annrheumdis-2019-215372
World Health Organization. WHO guidelines on physical activity and sedentary behaviour. Geneva: WHO; 2020. ISBN:978-92-4-001512-8
Petersen EW, Carey AL, Sacchetti M, et al. Acute IL-6 response to exercise is independent of muscle damage. J Appl Physiol. 2005;98(3):944-949. doi:10.1152/japplphysiol.01095.2004
Sparks JA, Costenbader KH. Does physical activity protect against the development of rheumatoid arthritis? Arthritis Res Ther. 2014;16(2):109. doi:10.1186/ar4553
Metsios GS, Stavropoulos-Kalinoglou A, Sandoo A, et al. Vascular function and inflammation in rheumatoid arthritis: the role of aerobic exercise. Open Cardiovasc Med J. 2010;4:89-96. doi:10.2174/1874192401004010089
Bartlett DB, Willis LH, Slentz CA, et al. Ten weeks of brisk walking improves cutaneous microvascular function in healthy older adults. J Appl Physiol. 2013;114(4):472-478. doi:10.1152/japplphysiol.01035.2012
Bartlett DB, Willis LH, Slentz CA, Hoselton A, Huebner JL, Kraus VB, Moss J, Muehlbauer MJ, Spielmann G, Kraus WE, Lord JM, Huffman KM. Ten weeks of high-intensity interval walk training is associated with reduced disease activity and improved innate immune function in older adults with rheumatoid arthritis: a pilot study. Arthritis Res Ther. 2018;20(1):127. doi:10.1186/s13075-018-1624-x
Gerlag DM, Raza K, van Baarsen LGM, et al. EULAR recommendations for terminology and research in individuals at risk of rheumatoid arthritis. Ann Rheum Dis. 2012;71(5):638-641. doi:10.1136/annrheumdis-2011-200990
Lancaster GI, Febbraio MA. The immunomodulating role of exercise in metabolic disease. Trends Immunol. 2014;35(6):262-269. doi:10.1016/j.it.2014.02.008
Pedersen BK, Saltin B. Exercise as medicine – evidence for prescribing exercise as therapy in 26 different chronic diseases. Scand J Med Sci Sports. 2015;25(S3):1-72. doi:10.1111/sms.12581
Shimizu T, Nakayama Y, Iwasaki T, et al. Effects of exercise on bone in rheumatoid arthritis: A systematic review. Mod Rheumatol. 2020;30(6):871-879. doi:10.1080/14397595.2019.1682280
Prince SA, Adamo KB, Hamel ME, et al. A comparison of direct versus self-report measures for assessing physical activity in adults: a systematic review. Int J Behav Nutr Phys Act. 2008;5:56. doi:10.1186/1479-5868-5-56
Schmidt WA, Gromnica-Ihle E. Imaging in rheumatology: Current status and future developments. Z Rheumatol. 2014;73(2):133-143. doi:10.1007/s00393-013-1307-2
Dougados M, Soubrier M, Antunez A, et al. Prevalence of comorbidities in rheumatoid arthritis and evaluation of their monitoring: results of an international, cross-sectional study (COMORA). Ann Rheum Dis. 2014;73(1):62-68. doi:10.1136/annrheumdis-2013-204223
Iversen MD, Frits ML, von Heideken J, et al. Physical activity and disease activity in adults with rheumatoid arthritis: data from the Brigham RA Sequential Study. Arthritis Care Res (Hoboken). 2017;69(10):1536-1543. doi:10.1002/acr.23173
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