Environmental and Lifestyle Factors in the Risk and Prevention of Rheumatoid Arthritis: A Narrative Review

Abstract

Rheumatoid arthritis (RA) is a chronic autoimmune disease with a multifactorial etiology, driven by a combination of genetic susceptibility and modifiable environmental and exposure factors. While environmental factors such as cigarette smoke, occupational exposures, air pollution, and infections increase the risk of developing RA, lifestyle and dietary factors, including adherence to the Mediterranean diet and adequate vitamin D intake, may offer protective benefits. Systemic factors like obesity, chronic stress, and vitamin D deficiency also contribute to disease onset, highlighting the complex interplay of risk and protective elements in RA development. This narrative review synthesizes the existing literature on environmental and lifestyle factors associated with RA, focusing on modifiable risks and preventive strategies. A comprehensive literature search was conducted using PubMed and Google Scholar up to 2025, with Boolean combinations of terms related to RA and its environmental and lifestyle triggers. The review highlights the importance of minimizing exposures to environmental triggers and adopting lifestyle modifications, such as a Mediterranean diet, for RA prevention. Although medications like statins and hormone replacement therapy show mixed results, the need for a multifaceted approach combining environmental control, lifestyle changes, and early intervention is emphasized. Further research is needed to refine preventive strategies and deepen understanding of RA pathogenesis, ultimately improving outcomes for individuals at high risk.

Keywords: autoimmune diseases; environmental exposures; lifestyle; modifiable risk factors; primary prevention; rheumatoid arthritis.