Association between combined healthy lifestyles and rheumatoid arthritis: A cross-sectional study based on the NHANES database

The aim of our research was to explore the relationship between healthy lifestyles and rheumatoid arthritis (RA). Data were collected from the National Health and Nutrition Examination Survey database from 1999 to 2018. The healthy lifestyle score (ranging from 0 to 5) was assessed based on current nonsmoking, low to moderate alcohol drinking, adequate physical activity, optimal waist circumference, and healthy diet. RA patients were identified from the questionnaire data. Weighted multiple regression analysis and subgroup analysis were employed to investigate the association between healthy lifestyles and RA. On this basis, a restricted cubic spline plot was used to examine the nonlinear relationship. A total of 25,325 patients were included in our study, among whom 1236 had RA. After adjusting for all covariates, the multivariable logistic regression analysis indicated that participants adhering to 4 to 5 healthy lifestyle behaviors had a lower probability of having RA compared to those adhering to 0 to 1 healthy lifestyle behaviors (odds ratio = 0.417, 95% confidence interval = 0.304-0.573, P < .001). The interaction test revealed an interaction effect of age. The weighted healthy lifestyle score was more effective in assessing the association between lifestyle and the presence of RA, and the restricted cubic spline plot demonstrated a linear relationship. Overall, adherence to a greater variety of healthy lifestyle behaviors shows a negative association with the occurrence of RA.