Associated lifestyle factors and comorbidities of difficult-to-treat rheumatoid arthritis: a systematic review and meta-analysis
Authors' conclusion
This systematic review and meta-analysis identified that smoking, obesity, fibromyalgia, and depression are significantly associated with occurrence of difficult-to-treat rheumatoid arthritis.
Study context
- Population
- Adults with RA (validated criteria); difficult-to-treat RA as defined by EULAR; studies from Jan 1, 2021, to Sept 1, 2025
- Participants
- 22,968 adults21 studies
- Comparison
- Lifestyle factors and comorbidities vs their absence, in relation to difficult-to-treat RA (EULAR definition)
- Outcome
- Association between predefined lifestyle factors and comorbidities and difficult-to-treat RA
Methodological detailsrandom-effects models, inverse-variance methods, Most studies of high quality; no significant publication bias detected
- Random-effects models
- Inverse-variance methods
- Most studies of high quality; no significant publication bias detected
Pooled result
As reported in the abstract
Association with difficult-to-treat RA
- Smoking history: OR
- 1.16 (95% CI 1.01 to 1.34; I2 =23%; 15 [71%] of 21 studies)
- Obesity: OR
- 1.38 (95% CI 1.11 to 1.72; I2 =0%; 8 [38%] studies)
- Fibromyalgia: OR
- 2.20 (95% CI 1.64 to 2.96; I2 =43%; 9 [43%] studies)
- Depression: OR
- 1.74 (95% CI 1.39 to 2.18; I2 =0%; 9 [43%] studies)
- Current smoking: OR, no association
- 1.23 (95% CI 0.98 to 1.55; I2 =0%; 9 [43%] studies)
- Anxiety: OR, no association
- 1.45 (95% CI 0.92 to 2.29; I2 =0%; 4 [19%] studies)
- BMI (continuous): MD in kg/m², no association
- 0.20 (95% CI −0.02 to 0.41; I2=12%; 11 [52%] studies)
Original publication
Associated lifestyle factors and comorbidities of difficult-to-treat rheumatoid arthritis: a systematic review and meta-analysis. Lancet Rheumatol. Published 15 April 2026. doi:10.
Composed by AI from the published abstract and checked against it. How Briefs are made →