Background/Purpose: Physical activity is a crucial factor in human health; lack thereof is the third most important cause of preventable deaths today.  Several biological mechanisms are affected by physical activity and decreasing markers of chronic inflammation have been shown in numerous studies. The aim of this study was to investigate whether the clinical presentation of rheumatoid arthritis (RA) might be affected by physical activity before disease onset. 

Methods: Among the cases from the large, population-based, case-control study EIRA, with clinical data from the Swedish Rheumatology Quality Register, we compared patients with regular physical activity 5 years before diagnosis  (N=288), to less active patients (N=329), we also investigated a possible dose-response relationship with physical activity in four levels. Logistic regression was used to calculate the odds of having above median level of 28-joint disease activity score (DAS28), physician assessment (5 categories), pain (visual-analog scale, VAS-pain) and activity limitation  (health assessment questionnaire, HAQ). The analyses were adjusted for potential confounders (sex, age at diagnosis, period of diagnosis, smoking, body mass index, alcohol consumption, socioeconomic status, vegetable intake and physically demanding work (5 years before diagnosis). 

Results: RA patients with regularphysical activity before diagnosis had statistically significant decreased odds of having DAS28, physician assessment, and/or VAS-pain above median, while HAQ was not affected (see Table). We further found indications of a dose-response relationship for physical activity and DAS28, physician assessment and VAS-pain, for HAQ, however, only in the highest category of physical activity gave an effect (OR= 0.49 [95% CI: 0.24 – 0.99]). Further; statistically significant effects were found both for the combined objective components (swollen joint count, erythrocyte sedimentation rate, C-reactive protein) and combined subjective components (tender joint count, patient global assessment) of DAS28. Neither anti-CCP positivity, body-mass index, sex, physically demanding work nor socioeconomic status modified the observed associations. 

Conclusion: The findings of this study implicate that RA patients who were physically active before disease onset present with a milder disease according to both patient-reported, physician-reported and laboratory measures. No previous studies have evaluated the influence of physical activity on the clinical presentation of RA. However, DAS28 has been reported to improve after physical activity interventions among established RA-patients, and some trials also reported improvements in VAS-pain and/or HAQ. The results of the present study adds to the growing evidence of the general health benefits of physical activity, and might be an important, helpful message for individuals at increased risk of RA.

	Physical activity at leisure time	Events (N)	OR	95% CI
DAS28 ≥5.3	No regular physical activity	189	1.00	Ref.
	Regular physical activity	122	0.56	0.39 – 0-82
Physician assessment >2	No regular physical activity	130	1.00	Ref.
	Regular physical activity	82	0.62	0.42 – 0.92
VAS-pain >50	No regular physical activity	181	1.00	Ref.
	Regular physical activity	127	0.67	0.47 – 0.98
HAQ ≥1	No regular physical activity	194	1.00	Ref.
	Regular physical activity	142	0.84	0.58 – 1.23

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/patients-with-regular-physical-activity-before-onset-of-rheumatoid-arthritis-present-with-milder-disease/