The study focused on 13,639 women from the Nurses Health Study who were followed between 1976 and 2002. During that time 683 (5.0%) of the women developed rheumatoid arthritis. The researchers found that women with a birth weight greater than 10 pounds (4.54 kg) were 2.1 times more likely to develop rheumatoid arthritis than women with a normal birth weight between 7 and 8.5 pounds (3.2 to 3.85 kg).

While the mechanism which links heavy babies to rheumatoid arthritis is unknown, researchers believe that hormone imbalances observed in rheumatoid arthritis sufferers may be “programmed” during early fetal development.

The study adds support to the idea suggesting that the probability of developing certain diseases may be influenced by processes that occur during pregnancy, a theory known as the “fetal origins of adult disease hypothesis”. A low birth-weight for example has been linked to an increased risk of heart disease and type-2 diabetes while a high birth-weight has been linked to certain cancers such as leukemia, colo-rectal, ovarian, prostate, and breast cancer.

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The study, conducted by researchers at the Malmo University Hospital in Sweden, compared 136 individuals who had been diagnosed with rheumatoid arthritis to 544 women who were free of the illness.

The researchers found that when compared to not breast-feeding at all, breastfeeding for between one month and a year reduced rheumatoid arthritis risk by 26% while breast feeding for more than 13 months cut the risk by 54%.

The authors noted that the study was quite small and further research is required to establish the link between breastfeeding and rheumatoid arthritis.

The results of this study are actually in contrast with others which have found a slight increase in arthritis risk amongst breast-feeding mothers.

Breast-feeding raises the levels of certain hormones that may have both positive and negative effects on arthritis risk. The hormone prolactin for example is known to stimulate the immune system and may increase arthritis risk in the short term because rheumatoid arthritis is an autoimmune disease.

The percentage of mothers who breast-feed is currently increasing however most stop well before the baby reaches one year of age. Around 75% of mothers start out by breast-feeding with 40% still breast-feeding when the child is six months of age. Just 20% of mothers breast-feed for more than a year.

The researchers also looked at use of the oral contraceptive pill and the risk of arthritis but failed to find a significant link between the two.

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Researchers compared mice who were fed water containing 0.2% green tea polyphenols with mice who received pure water for the presence and severity of arthritis after the mice were injected with collagen in order to induce arthritis.

In three independent studies, the mice in the group fed the green tea extract were less likely to develop arthritis, developing arthritis later in life, and experienced less severe arthritis. In the first study 33% of mice developed arthritis in the green tea group compared to 100% in the pure water group. The average time to the onset of arthritis symptoms was 38 days for the green tea group and 32 days for the control group.

Results were similar in the other two studies with 50% of the mice developing arthritis in the green tea groups in the second and third studies and 100% and 83% of the mice in the control groups developing arthritis. The mean time to onset of arthritis in the green tea group was 36 and 45 days for studies two and three respectively compared to 32 days in both of the control groups.

Across the three studies combined, 44% of the mice fed the green tea extract developed arthritis while 94% of the mice who received water only developed arthritis.

The severity of arthritis as measured by the arthritis index was also greater in the control groups than the green tea groups. Arthritis index scores were 1.00, 1.16 and 1.33 for the green tea groups and 4.16, 4.66 and 4.00 in the control groups.

Lead researcher Tariq M. Haqqi, who is the associate professor of medicine at Case Western Reserve University in Cleveland added that “Extensive laboratory research and the epidemiologic findings of the last 15 years have revealed that polyphenolic compounds present in green tea may prevent the onset and subsequent progression of a variety of illnesses. Perhaps now arthritis can be added to the list. ”

Tea is the most popular beverage in the world after water however the majority consumed is black tea which is not as rich in antioxidants and phenolic compounds as green tea. Green tea is very popular in Asian countries but is only recently gained popularity in the western world.

It is believed that green tea may help prevent cardiovascular disease and some studies have shown consumption of green tea may reduce the incidence of some cancers such as prostate cancer. Polyphenol compounds known as epicatechins are thought to be responsible for the beneficial effects of green tea.

Those who have early stage rheumatoid arthritis, or who believe they may be at risk of the disease should consider switching from drinking coffee to tea as some studies have linked regular coffee consumption with an increased risk of arthritis.

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The largest study on the benefits of vitamin D on rheumatoid arthritis was published in January 2004 in the journal Arthritis and Rheumatism. Researchers in that study analyzed 29,368 women who had participated in the Iowa Womens Health Study. The participants were aged between 55 and 69 and were initially free of rheumatoid arthritis. They were followed over an 11 year study period between 1986 and 1997.

During the study 152 cases of rheumatoid arthritis were identified. The researchers found that those who consumed more than 200 IU of vitamin D each day were 33% less likely to develop rheumatoid arthritis than those who consumed less than 200 IU of vitamin D. The associations were similar for vitamin D intake from both dietary sources and vitamin supplementation and the associations remained after the results were adjusted for other potential risk factors such as BMI and smoking.

The study did not however consider sunlight exposure, which is an important source of vitamin D, which may weaken the significance of the findings.

Vitamin D along with calcium are important for maintaining healthy joints and cartilage and preventing the loss of bone density. Vitamin D is also an immunosuppressant and because rheumatoid arthritis is an autoimmune disorder where an individuals immune system attacks cells in the joints causing inflammation, vitamin D may help prevent this from occurring

The recommended daily intake of vitamin D per day is 200 IU/day for people up to the age of 50 and 400 IU/day for those over the age of 50 however vitamin D is thought to be safe in doses up to 10,000 IU/day. Significant dietary sources of vitamin D include mushrooms (200-1000 IU/serving), cod liver oil, salmon (360 IU/serving), tuna (200 IU/serving), eggs (20 IU/egg), and fortified beverages such as milk and orange juice.

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The largest study on the impact of smoking on rheumatoid arthritis was conducted in 2001 by British researchers. In that study, 239 people who had been diagnosed with rheumatoid arthritis were compared to 239 controls, matched for age, sex, and job status, who were free of rheumatoid arthritis.

In the rheumatoid arthritis group, 100 (42%) were current smokers compared to just 52 (22%) current smokers in the control group. 55 (23%) of the rheumatoid arthritis group were ex-smokers while 84 (35%) had never smoked at all. The average age of both groups was 60.5 years.

The researchers found that those people who had never smoked were almost half as likely to develop rheumatoid arthritis compared to those who had ever smoked. The researchers also found a strong correlation between heavy smoking and rheumatoid arthritis. Those who had smoked between 31 and 40 pack had 5.72 times greater odds of developing rheumatoid arthritis and those who smoked between 41 and 50 pack years had 13.54 times greater odds of developing rheumatoid arthritis.

A pack year was defined as a year of smoking 20 cigarettes per day. An individual who smoked 40 cigarettes a day for 30 years would therefore be considered to have smoked for 60 pack years.

It is believed that smoking may increase the levels in the blood of an antibody called rheumatoid factor (RF). RF antibodies are found in the majority of rheumatoid arthritis sufferers and the antibody is a strong indication of the likelihood a person will develop rheumatoid arthritis. Just 5% of people without rheumatoid arthritis have RF while 70% of people with rheumatoid arthritis have the antibody.

While genetics plays a large role in whether a person will have the RF antibodies, some lifestyle factors are also thought to contribute to the development of RF. It is believed that smoking is one of these factors because RF is present more often, and at higher levels in smokers compared to non smokers. An American study, published in the journal Annals of the Rheumatic Diseases in 1997 found that those who had smoked for more than 25 pack years were 3.1 times more likely to test positive for RF antibodies than non-smokers.

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One study, published in the journal Circulation in 2003 involved 114,342 women from the Nurses Health Study who were followed for 18 years. At the end of the study, 7,786 women (7%) reported to have developed symptoms of rheumatoid arthritis. The researchers found that both heart attacks and strokes were more common in women with rheumatoid arthritis relative to those without the disease.

After controlling for several variables including cholesterol, age, physical activity, BMI, and alcohol consumption, heart attacks were found to be twice as common in the rheumatoid arthritis group compared to the women without rheumatoid arthritis. Strokes were 1.5 times more common in the rheumatoid arthritis group however the association between strokes and rheumatoid arthritis was not statistically significant at the 95% confidence level.

A second study, published in 2006 by researchers out of Boston found similar results. That study included both men and women and found that rheumatoid arthritis sufferers were 1.6 times more likely to have one of three events: a stroke, a heart attack, or dying from cardiovascular disease.

The study also found that people who developed rheumatoid arthritis at a young age (before 40) had the greatest increase in cardiovascular risk. They were 3.3 times more likely to have one of the three events than a person of the same age without the illness.

While rheumatoid arthritis does not appear to be as significant a risk factor for cardiovascular disease as other known risk factors such as diabetes, hypertension, or obesity - rheumatoid arthritis sufferers do appear to be at a small, but significant increased risk of cardiovascular disease and therefore need to take extra care of their heart.

It is thought that certain genes, that are known to increase the risk of developing rheumatoid arthritis may also increase the risk of cardiovascular disease. It is also possible that heavy use of NSAID’s and other drugs used to treat rheumatoid arthritis may also increase cardiovascular disease risk.

According to Dr. Christopher Edwards, one of the authors of the Boston study, “Our findings are just another piece of evidence that demonstrates rheumatoid arthritis is a systemic disease and patients need systemic care. You can’t just look after their joints.”

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Researchers at the Gothenburg University in Sweden injected mice with collagen to initiate collagen induced arthritis (CIA) in the mice. The mice were injected at the beginning of the experiment and received an additional injection after three weeks. CIA development in mice is as established model of rheumatoid arthritis in humans.

25 of the mice drank water with 10% ethanol added while the remaining 27 mice received water only. 30 days into the study (9 days after the booster injections), 23 of the 27 control mice (85%) had developed collagen induced arthritis while just 5 of the 25 (20%) mice that drank ethanol developed arthritis.

After five weeks, all of the control mice had developed arthritis while more than 60% of the ethanol drinking mice remained free of arthritis. Furthermore, arthritis was less severe in the ethanol fed mice with less inflammation of joints and destruction of bone and cartilage observed.

Researchers believe that moderate alcohol consumption may increase testosterone levels circulating in the body. In the mice study, ethanol consumption led to a significant increase in testosterone levels compared to the control mice.

Treatment of arthritis with testosterone is known to reduce the severity of arthritis. Testosterone restricts the releasing of certain proteins known as cytokines that are known to cause inflammation in the body. This is reinforced by the observation that males, especially younger males are less likely to develop rheumatoid arthritis at a given age than females.

Studies on the effects of alcohol on testosterone in humans have been mixed however with some studies finding that heavy alcohol consumption actually inhibits testosterone secretion and reduces testosterone levels in the body.

The researchers also found, that acetaldehyde or ethanal, which is produced when the body metabolizes alcohol, produces a similar protective effect against arthritis.

While mild alcohol consumption may benefit arthritis sufferers in addition to protecting against cardiovascular disease, heavy alcohol intake is known to increase heart disease risk, cause brain and liver damage and depress the immune system, raising the risks of developing infections such as pneumonia and tuberculosis.

According to Professor Andrej Tarkowski, who led the research, it is difficult to translate the ethanol dose received by the mice into an amount that would create a similar effect in humans:”We can’t translate these results to find out the therapeutic dose in humans. The mice were given a dose of 10% of alcohol in their water, but we don’t know if it would be the same for humans. It would probably be lower.”

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97 patients took part in the nine month study which involved individuals being randomly assigned to a group receiving either a 10g cod liver oil capsule each day or an air filled placebo capsule. The participants were asked to gradually reduce or stop their NSAID intake.

At the conclusion of the study, 39% of the cod liver oil group were able to reduce their intake of NSAID’s by at least 30% while only 10% of the placebo group were able to reduce their NSAID intake by the same amount. Overall the cod liver oil group were able to reduce NSAID intake by an average of 40% while the placebo group achieved only a 16% reduction in NSAID usage.

Patients in the cod liver oil group also reported a significant reduction in pain as measured by the Visual Analogue Scale (VAS) compared to those in the placebo group.

While NSAID’s are relatively safe, their long term use can cause gastrointestinal problems including stomach ulcers, vomiting, and diarrhea. They may also increase the risk of cardiovascular events such as strokes and heart attacks, particularly in the elderly. For these reasons, doctors advise against long term, high dose usage of NSAID’s when possible.

The most common NSAID’s used by arthritis sufferers include aspirin, ibuprofen. voltaren, naproxen, and celebrex.

According to Alisa Bosworth, who is the United Kingdom National Rheumatoid Arthritis Society chief executive “People with rheumatoid arthritis still rely heavily on NSAID’s, even though the safety of these drugs is under scrutiny.”

Researchers believe the anti-inflammatory properties of the omega three essential fatty acids, DHA and EPA, which are found in high levels in cod liver oil are behind the reductions in pain. 10g of cod liver oil contains 2.2g of essential fatty acids.

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The study, lead by researchers at the Karolisnka Institute in Stockholm, Sweden, followed 66 volunteers who had been diagnosed with rheumatoid arthritis. 38 of the volunteers followed a vegan diet consisting of foods such as nuts, seeds, fruit and vegetables. The diet consisted of around 10% protein, 60% carbohydrate, and 30% fats. The other 28 followed a healthy, non-vegan diet with the same proportions of carbohydrates, fats and protein. The volunteers remained on the diets for a year.

Those who switched to the vegan diet showed an improvement in the number of swollen joints they had, from an average of 5.3 joints to 4.3 joints. Those on the vegan diet also had reduced amounts of C-reactive protein (CRP) circulating in the blood, CRP is a measure of the amount of inflammation in the body, high CRP levels are associated with rheumatoid arthritis and cardiovascular problems such as heart disease and strokes.

Those on the vegan diet also had higher levels of natural antibodies known as antiPC. AntiPC antibodies are thought to help protect against damaging compounds in the body that are thought to cause cardiovascular disease and arthritis.

The vegans also experienced reductions in body mass index and LDL cholesterol levels. HDL cholesterol levels and triglyceride levels remained the same.

The authors of the study, which is published in the journal Arthritis & Therapy, concede that larger studies need to be conducted to confirm the benefits of vegan diets for those suffering rheumatoid arthritis.

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One study, conducted by researchers at the University of Manchester and published in the American Journal of Clinical Nutrition involved following 25,000 participants between 1993 and 2001. During the study period 88 people developed inflammatory polyarthritis, their dietary habits were compared to 176 healthy people serving as controls.

On average, those who developed arthritis had a 20 percent lower daily intake of the carotenoid zeaxanthin and a 40 percent lower daily intake of beta-cryptoxanthin. Furthermore those individuals in the top-third of zeaxanthin intake had a 52 percent reduced risk of arthritis compared to those in the bottom-third of zeaxanthin intake. Those in the top-third for beta-cryptoxanthin intake were at a 48 percent reduced risk of developing arthritis.

The study however failed to find an association between high intakes of two other carotenoids, lutein and lycopene, and reduced arthritis risk.

The amount of beta-cryptoxanthin required to put an individual in the highest third of beta-cryptoxanthin intake in this study is the equivalent of just a glass of orange juice a day. Foods high in beta-cryptoxanthin include red peppers, pumpkin, tangerines, peaches, oranges, pineapples, papayas, lemons, other yellow and orange fruits and herbs such as paprika. Studies have also shown that beta-cryptoxanthin can improve lung function and reduce the risk of lung cancer.

Foods high in zeaxanthin include corn, egg yolk, oranges, honeydew melons, orange peppers, and mangoes. Zeaxanthin also plays an essential role in eye health and may reduce the affects of macular degeneration.

This study appears to confirm previous findings that diets high in fruits, particularly those rich in carotenoids, may reduce arthritis risk. The Iowa Women’s Health Study, which involved more than 29,000 women had found that the incidence of rheumatoid arthritis was much lower amongst those who consumed high levels of beta-cryptoxanthin.

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The majority of arthritis cases occur through wear and tear of joints, particularly the hip and knee. It is well known however that a small number of arthritis cases are the result of joint fractures. It had also been suspected that sprains in strains of joints such as the ankle could also lead to arthritis.

The researchers, based at the University of Basel in northern Switzerland, studied 268 patients who had presented with arthritis of the ankle. A massive 221 (82.5 percent) of these individuals had experienced a fracture of the ankle. A further 47 (17.5 percent) of the individuals have experienced repeated ankle sprains and/or chronic ankle stability.

Interestingly the delay between the onset of ankle problems and arthritis was quite long, those with ankle fractures developed arthritis on average 21 years after the fracture. In the group with ankle sprains, arthritis developed in average 22.5 years later.

One of the researchers, Dr. Victor Valderrabano, who is based at the Orthopedic Department at the University of Basel suggests that chronic instability of the ankle joint may increase the forces acting on it leading to increased wear and tear and consequently an increase in the risk of inflammation and arthritis development.

Ankle sprains and strains are the most common injuries experienced in sports and recreational activities. They are particularly common in running and jumping sports, accounting for over a quarter of all injuries.

Ankle care and rehabilitation following injuries is often inadequate with around a third of ankle injuries progressing to chronic ankle instability. Around three-quarters of people with chronic ankle instability will go on to develop arthritis of the ankle.

The researchers stressed the need for adequate rehabilitation of ankle injuries to prevent complications later in life. “The person should strengthen muscles to become more immune to injury. Follow-up with a doctor to determine if the ankle is still unstable is crucial, too,” concluded the research team.

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Some studies have also linked weight with other forms of osteoarthritis such as osteoarthritis in the hands which suggests there may be other factors associated with weight gain that increase osteoarthritis risk besides the extra load on weight bearing joints.

It is estimated that the force exerted on the knee joints while walking is between 2 to 7 times a persons body weight. This means a person just 20 pounds heavier than their ideal weight could be exerting more than 100 pounds of additional force on each knee joint.

Data from the first National Health and Nutrition Examination Survey (HANES I) has suggested that obese women are almost four times more likely to develop osteoarthritis in the knee compared to women of a healthy weight and that obese men are as much as five times more likely to develop osteoarthritis in the knee.

Another study called “Age, bodyweight, smoking habits and the risk of severe osteoarthritis in the hip and knee in men” which was published in the European Journal of Epidemology” involved over 320,000 male construction workers. The study found a linear correlation between BMI and the incidence of osteoarthritis in both the hip and knee. This correlation was present even through the low and normal BMI levels. An increase in BMI of 5 doubled the risk of developing osteoarthritis in the knee.

Finally a study in the Journal of Rheumatology which involved studying pairs of twins found that obesity was a risk factor in the development of both arthritis in the hands and in the joints of the knee. Overall the study found that the risk of developing osteoarthritis increased by between 9 and 13 percent per kg increase in body weight.

The good news is that losing even a moderate amount of weight can reduce your chances of developing arthritis significantly. Furthermore those who have already developed arthritis can reduce both the pain caused by their arthritis and the progression of the disease by managing their weight.

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The study which was funded by the Arthritis Research Campaign and led by Dr. Tracey M. Farragher at the University of Manchester involved over 1,000 individuals with arthritis. At the conclusion of the study 242 of the patients had died with cardiovascular disease responsible for just under a third of the deaths.

The researchers found that individuals with a particular combination of a gene called HLA-DRB1, which is associated with an increased risk of developing rheumatoid arthritis, were three times more likely to develop cardiovascular disease than those without the gene combination. Furthermore their appeared to be interactions between those individuals with the gene combination and who also smoked that increased the risk of cardiovascular disease even further.

According to Professor Alan Silman, who was involved in the research “We have known for some time that smoking is a major risk factor for developing rheumatoid arthritis, but this study confirms that rheumatoid arthritis patients with this particular genetic variant who continue to smoke are putting themselves in considerable danger of life-threatening cardiovascular disease.”

The inflammation associated with rheumatoid arthritis is thought to be associated with atherosclerosis (hardening of the arteries) which increases the likelihood of an individual suffering a heart attack or stroke. It is also possible that decreased exercise seen in individuals suffering from arthritis may also be responsible for increasing cardiovascular risk.

The research is reported in issue two of the February 2008 edition of “Arthritis & Rheumatism”, a peer reviewed journal of the American College of Rheumatology.

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Probably the largest clinical study of glucosamine’s effectiveness was funded by the National Institutes of Health (NIH), which is an agency of the US Department of Health and Human Services, and involved a 6 month trial where osteoarthritis patients received one of five treatments. The treatments were glucosamine supplementation, chondroitin supplementation, a combination of both, a NSAID used for treating arthritis called celecoxib, or a placebo.

The researchers found that neither glucosamine nor chondroitin reduced arthritis pain compared to the placebo, however a subgroup of the patients did experience a statistically significant benefit from taking both supplements.

A separate study called “Glucosamine and chondroitin for treatment of osteoarthritis: A systematic quality assessment and meta-analysis” which was published in the Journal of the American Medical Association in 2000 and involved analyzing data from a large number of clinical trials concluded that “Trials of glucosamine and chondroitin preparations for OA symptoms demonstrate moderate to large effects, but quality issues and likely publication bias suggest that these effects are exaggerated. Nevertheless, some degree of efficacy appears probable for these preparations.”

A third study published in the Lancet, a British medical journal, found that in a trial involving 212 individuals with osteoarthritis, symptoms improved by 20 to 25 percent in the glucosamine group compared to a slight worsening of symptoms in the control group. Furthermore x-ray examinations of patients showed that the glucosamine group had reduced narrowing of the knee-join space, an indicator of osteoarthritis progression, when compared to the control group.

Benefits to osteoarthritis sufferers from glucosamine are thought to come through one of two mechanisms. First, through glucosamine’s anti-inflammatory action that can help reduce the pain associated with arthritis, and secondly, by stimulating the production of both proteoglycans and collagen, which are both essential elements of healthy cartilage.

Despite conflicting claims on the effectiveness of glucosamine, it has an excellent safety profile and with very few side-effects, even with long term use at high doses, it is probably worth a try for osteoarthritis sufferers.

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