An abstract presented at this year's American College of Rheumatology (ACR) conference asked whether the likelihood of being diagnosed with systemic lupus erythematosus (SLE) in the future could be modified by healthy lifestyle behavior. The abstract analyzed data using the Nurses' Health Study (NHS) I (1976-2016) and NHS II (1989-2017) and looked at three lifestyle behaviors to calculate a Healthy Lifestyle Index Score (HLIS). The data were captured at the beginning of the study and biennially thereafter.
The three lifestyle behaviors analyzed were alcohol intake, body mass index (BMI), and smoking status. Low risk/"healthy" behaviors were described as: "moderate" intake of alcohol, defined as 5 g to 15 g per day (~12 oz of beer, 1.5 oz of hard liquor, or 5 oz of wine); never smoking or quitting more than 4 years previously; and BMI of 18.5 to 24.9 kg/m2. The study included 217,623 female nurses. There were 283 incident SLE cases during 5,815,233 person-years of follow-up. The findings showed that a higher HLIS was associated with a lower SLE risk overall (HR 0.75 [95% CI 0.64-0.88]). Women who consumed "moderate" amounts of alcohol had a lower risk of developing SLE compared with those who consumed less alcohol (HR 0.62 [95% CI 0.46-0.83]). In addition, women who were never smokers or who had quit more than 4 years ago were less likely to develop anti-double stranded (ds) DNA positive SLE (HR 0.55 [95% CI 0.36-0.85]) compared with current smokers and those who had quit within the last 4 years.
In the final analysis, women who were able to follow all three lifestyle behaviors had a 43% lower risk of developing SLE than those who were not. However, the population studied was all female, and therefore we cannot extrapolate the impact of these lifestyle behaviors to men. In addition, the reviewers noted the impact of poverty and its attendant issues could not be studied in this cohort. Nonetheless, I was surprised to learn that healthy lifestyles could significantly reduce development of SLE. Going forward, it seems that patients who have a positive family history of SLE and/or those who are antinuclear antibody-positive and dsDNA-positive could have a 43% lower risk of developing SLE if they follow the three lifestyle behaviors described above.