Systemic inflammation and malnutrition increased the risk of rheumatoid arthritis, finds study

A new study published in the journal of Clinical Rheumatology showed that high levels of systemic inflammation and malnutrition were both independent risk factors for rheumatoid arthritis (RA) patients' prognosis, and their co-occurrence can worsen the prognosis even more.

The cause of rheumatoid arthritis (RA), a chronic inflammatory illness mediated by the immune system, remains uncertain. It has a significant impact on the joints and is linked to disability, multimorbidity, a lower life expectancy, and a greater financial, social, and health cost when left untreated. Although it can start at any point in life, its frequency rises with age. According to recent research, elderly people had worse health outcomes and more severe RA.

Because of their weakened health, elderly RA patients could receive less intense therapy and be prescribed less biologics and conventional synthetic disease-modifying antirheumatic medications (csDMARDs), which might have a greater detrimental effect on their health. People with RA often suffer from malnutrition and systemic inflammation. The combined effects of inflammatory and nutritional levels on all-cause mortality in RA patients, however, have not been well investigated in research. Thus, Zhuang Ma and team investigated to look into these possible correlations.

A total of 2,213 individuals with RA from the National Health and Nutrition Examination Survey (2001–2018) participated in this study. The participants' nutritional and inflammatory statuses were assessed using the Nutritional Risk Index (NRI) and the Systemic Inflammatory Response Index (SIRI), respectively. To determine the independent and combined relationship, weight-based Kaplan-Meier survival curves and COX proportional hazard models were utilized.

There were 544 fatalities with a median follow-up of 7.98 years. After controlling for confounding variables, this study discovered that those with high SIRI or moderate/severe malnutrition were independently linked to a higher risk of dying from all causes.

Additionally, the risk of death was substantially increased by the co-occurrence of moderate to severe malnutrition and a high SIRI. Malnutrition and high SIRI were found to interact additively, resulting in an increased risk of 0.34 and an attributable proportion of 20.9%.

Overall, this study focused on how inflammation and hunger together affect the risk of all-cause death in rheumatoid arthritis. Moderate to severe malnutrition doubled the risk, and a high systemic inflammatory response index (SIRI) increased the risk. The risk increased much more when both conditions were present, highlighting the need to manage inflammation and nutrition in RA treatment.

Reference:

Ma, Z., Wu, S., Xiong, L.-E., Zhong, J., Lin, B., Chen, L., Xiong, T., & Wu, Y. (2025). Interaction of nutritional and inflammatory levels on all-cause mortality among individuals with rheumatoid arthritis: a prospective cohort study. Clinical Rheumatology. https://doi.org/10.1007/s10067-025-07458-0