Multifactorial lifestyle interventions in rheumatoid arthritis: a systematic literature review

Objectives: Although research investigating the role of lifestyle factors in rheumatoid arthritis (RA) management is growing, evidence regarding multifactorial lifestyle interventions remains limited. The aim of this systematic review is to examine the evidence on multifactorial lifestyle interventions for adults with RA and their effects on disease activity, inflammatory markers, fatigue, physical function, pain, and quality of life. Methods: Five databases (PubMed, SPORTdiscus, Embase, Medline, and CINAHL) were searched in February 2024 and June 2026 to retrieve clinical trials investigating lifestyle interventions in adults with RA on disease activity, inflammatory markers, pain, function, fatigue, and quality of life. Risk of bias was assessed using the Cochrane Risk of Bias tool. Key study data were extracted, and because of study heterogeneity, results were synthesised narratively. Results: Of 2992 screened records, 12 studies met the inclusion criteria, including a total of 660 participants. Some studies demonstrated significant and clinically important improvements in outcome measures; however, findings varied across studies and outcome measures. Two studies demonstrated potential advantages of multifactorial lifestyle interventions over single-component interventions. Conclusions: Multifactorial lifestyle interventions may improve disease activity and other core outcome measures in adults. However, findings were inconsistent across studies, with interpretation limited by varying baseline characteristics, small sample sizes, methodological limitations, and low-certainty evidence. Larger, high-quality trials are needed to confirm these findings and evaluate the effectiveness, feasibility, acceptability, and implementation of multifactorial lifestyle interventions in RA management.