From the Guidelines
Rheumatoid arthritis (RA) attacks or flares can be triggered by various factors, including genetic and environmental risk factors, such as the presence of serum autoantibodies, particularly anti-citrullinated protein antibodies (ACPA), and omega-3 fatty acid levels, as well as other factors like stress, infections, and changes in hormone levels. According to the most recent study 1, asymptomatic at-risk individuals, such as first-degree relatives (FDRs) of people with RA, are more likely to develop RA due to genetic and environmental risk factors. The study found that serum ACPA are enriched in FDRs and associated with arthritis development, and that omega-3 fatty acid levels appear to have an inverse relationship with anti-cyclic citrullinated protein (anti-CCP) antibodies in those with genetic risk.
Some of the key triggers for RA attacks include:
- Genetic risk factors, such as the presence of the shared epitope (SE) encoding allele HLA-DRB1*1402, which is almost unique to Indigenous Peoples 1
- Environmental risk factors, such as exposure to certain infections or changes in hormone levels
- Stress, which can exacerbate symptoms and trigger flares
- Poor sleep and changes in physical activity levels
- Certain foods, particularly those high in sugar, saturated fats, or processed ingredients, which may increase inflammation and trigger flares in some individuals
- Overexertion or injury to joints, which can lead to increased RA activity
- Smoking, which is a known risk factor for RA and can worsen symptoms
To minimize the risk of RA attacks, it's crucial to:
- Maintain a consistent treatment plan, including medication regimens and lifestyle modifications
- Practice stress management techniques, such as meditation or yoga
- Get adequate sleep and engage in regular exercise within your limits
- Eat a balanced anti-inflammatory diet, including foods rich in omega-3 fatty acids
- Avoid smoking and protect joints from injury
- Regularly monitor serum autoantibody levels and adjust treatment plans accordingly, as recommended by the European League Against Rheumatism (EULAR) 1.
Overall, understanding these triggers and taking steps to manage them can help individuals with RA better manage their condition and reduce the frequency and severity of attacks, as supported by studies such as 1.
From the Research
Triggers of Rheumatoid Arthritis (RA) Attack
- Rheumatoid arthritis (RA) is a chronic rheumatic disease of unknown aetiology and variable severity, with several risk factors involved in its pathogenesis, including genetic factors, sex hormones, environmental factors, infections, and stress 2
- Stress is recognized as an important risk factor for the onset and modulation of disease activity in RA, with chronic mild stress leading to proinflammatory effects and increasing disease activity 2
- Various infectious agents, environmental factors, physical trauma, silica, and food sensitivities have been documented as potential causes of RA or RA flares in different populations 3
- The initiating cause of RA or RA flare affects the type of joint damage, initial inflammatory response, adaptive immune response, and potential molecular mimicry, making treatment decisions complicated 3
- Factors underlying chronic inflammation in RA include susceptibility genes, disease-causing immune cells, and cytokine and signal transduction networks involved in promoting persistence of inflammation 4
- The pathogenesis of RA involves immunological basis, inflammatory pathways, genetic and epigenetic alterations, and metabolic disorders, with abnormality of immune cells atlas, epigenetics, and immunometabolism playing a key role 5
- Cellular factors like osteoclasts, synovial fibroblasts, T cells, B cells, and soluble factors like interleukin-1 (IL-1), IL-6, IL-17, and tumor necrosis factor-α (TNF-α) are involved in the development of RA 6