English Abstract This document reviews the latest state of knowledge
concerning the etiology, determinants and possibilities for prevention by
intervention on life-style factors for rheumatoid arthritis. Both primary,
secondary and tertiary prevention are covered. The etiology of rheumatoid
arthritis is still unknown, although it becomes more and more clear that
rheumatoid arthritis is an auto-immune disease. Most of the determinants
play a role in the course of the disease and do not play a role in the
etiology. Primary prevention, in which new cases of rheumatoid arthritis do
not occur because the causes have been eliminated, is not possible because
the etiology of rheumatoid arthritis is still unknwon. Secondary
prevention, the detection and treatment of a disease before the 'patient'
becomes aware of it, is also not possible bacause there is no known
determinant or a combination of determinants that can identify people with
rheumatoid arthritis before they are diagnosed as such. Early detection by
the general practitioner is important because the treatment can start in an
early stage of the disease. Early detection is going to be more important
as soon as an immunotherapy is developed that prevents joint destruction.
In the future it might be possible to conduct tertiary prevention, limiting
the damage of an established disease, by intervention on life-style factors
that are determinants for rheumatoid arthritis. Most of the research is
done on the effect of diet on the course of rheumatoid arthritis. It seems
that fish oil supplements and the consumption of fish improve the health of
patients with rheumatoid arthritis. Physical activity is also very
important for patients with rheumatoid arthritis because this may prevent
functional loss. Not only therapeutic exercise but also recreational
exercise should be stimulated. Changes in life style will not cure the
patient but the patient might feel better because she/he has less pain or
feels less dependent of other people.
