Associated lifestyle factors and comorbidities of difficult-to-treat rheumatoid arthritis: a systematic review and meta-analysis.

We aimed to quantify the associations between key lifestyle factors, comorbidities, and difficult-to-treat rheumatoid arthritis risk.

我们的目标是量化关键生活方式因素、合并症与难治性类风湿性关节炎风险之间的关联。

Methods

In this systematic reviewand meta-analysiswe systematically searched PubMed, Embase, and Cochrane Library from Jan 1, 2021, to Sept 1, 2025, for observational studies examining predefined lifestyle factors and comorbidities in relation to difficult-to-treat rheumatoid arthritis, as defined by the European Alliance of Associations for Rheumatology.

在这项系统评价和荟萃分析中，我们系统地检索了2021年1月1日至2025年9月1日期间在PubMed、Embase和Cochrane图书馆上发表的观察性研究，这些研究检查了预定义的生活方式因素和合并症与难治性类风湿关节炎之间的关系，后者由欧洲风湿病学会联盟定义。

Eligible studies were required to include adult rheumatoid arthritis populations with validated criteria, apply the European Alliance of Associations for Rheumatology definition of difficult-to-treat rheumatoid arthritis, and report adjusted effect estimates or sufficient data for calculation.

符合条件的研究必须包括使用经过验证标准的成人类风湿关节炎人群，应用欧洲风湿病学会联盟对难治性类风湿关节炎的定义，并报告调整后的效应估计值或足够的数据以供计算。

Pooled odds ratios (ORs) or mean differences with 95% CIs were calculated using inverse-variance methods with random-effects models.

使用逆方差方法和随机效应模型计算了汇总的比值比(ORs)或均值差异及其95%置信区间。

Data were extracted independently by two reviewers using a standardised form, with methodological quality assessed using the Newcastle-Ottawa Scale and the Agency for Healthcare Research and Quality checklist.

数据由两位评审员独立提取，使用标准化表格，并使用纽卡斯尔-渥太华量表和卫生保健研究与质量机构清单评估方法学质量。

The primary outcome was the association between predefined lifestyle factors and comorbidities and difficult-to-treat rheumatoid arthritis.

主要结果是预定义的生活方式因素和合并症与难治性类风湿性关节炎之间的关联。

People with lived experience of rheumatoid arthritis were not involved in the study.

研究中没有涉及有类风湿性关节炎生活经历的人。

The study was registered with PROSPERO (CRD420251148710).

该研究已在PROSPERO注册（CRD420251148710）。

Results

21 studies (22 968 patients with rheumatoid arthritis, of which 2783 had difficult-to-treat rheumatoid arthritis) were included.

共纳入了21项研究（22,968名类风湿关节炎患者，其中2,783名为难治性类风湿关节炎患者）。

Significant associations were observed for smoking history (OR 1·16, 95% CI 1·01 to 1·34; I2 =23%; 15 [71%] of 21 studies), obesity (1·38, 1·11 to 1·72; I2 =0%; eight [38%] studies), fibromyalgia (2·20, 1·64 to 2·96; I2 =43%; nine [43%] studies), and depression (1·74, 1·39 to 2·18; I2 =0%; nine [43%] studies).

观察到吸烟史(OR 1·16, 95% CI 1·01至1·34; I2=23%; 21项研究中有15项[71%])、肥胖(1·38, 1·11至1·72; I2=0%; 八项研究[38%])、纤维肌痛(2·20, 1·64至2·96; I2=43%; 九项研究[43%])和抑郁(1·74, 1·39至2·18; I2=0%; 九项研究[43%])之间存在显著关联。

No associations were found for current smoking (1·23, 0·98 to 1·55; I2 =0%; nine [43%] studies), anxiety (1·45, 0·92 to 2·29; I2 =0%; four [19%] studies), and BMI as a continuous measure (mean difference 0·20 kg/m2; 95% CI -0·02 to 0·41; I2=12%; 11 [52%] studies).

未发现当前吸烟(1·23, 0·98至1·55; I2=0%; 九项研究中有四项[43%])、焦虑(1·45, 0·92至2·29; I2=0%; 四项研究[19%])以及作为连续变量的BMI(平均差异0·20 kg/m2; 95% CI -0·02至0·41; I2=12%; 11项研究中有五项[52%])之间存在关联。

Analyses of socioeconomic status, osteoarthritis, and alcohol consumption were limited by few available studies.

社会经济地位、骨关节炎和酒精消费的分析因可获得的研究数量有限而受限。

Risk of bias assessment indicated that most studies were of high quality, and no significant publication bias was detected.

风险偏倚评估显示，大多数研究的质量较高，未发现明显的发表偏倚。

interpretation

This systematic reviewand meta-analysisidentified that smoking, obesity, fibromyalgia, and depression are significantly associated with occurrence of difficult-to-treat rheumatoid arthritis.

这项系统评价和荟萃分析发现，吸烟、肥胖、纤维肌痛和抑郁与难治性类风湿性关节炎的发生显著相关。

These findings support integrated management approaches that address both inflammatory pathways and risk factors in rheumatoid arthritis treatment strategies.

这些发现支持综合管理方法，这些方法在类风湿性关节炎治疗策略中既解决炎症途径也解决风险因素。

funding

National Natural Science Foundation of China.

中国国家自然科学基金。