Trajectories of health status and their association with rheumatoid arthritis risk: insights from a national prospective cohort study

BACKGROUND: The association between trajectories of different health states and rheumatoid arthritis (RA) is unknown. Our cohort study aimed to investigate the impact of various trajectories (including depressive symptoms, physical activity and multimorbidity status) on subsequent RA risk. METHODS: A prospective cohort study was conducted using seven waves of national data from the Health and Retirement Study (HRS 2004-2018) involving 9,795 US adults. A growth mixture model identified 6-year trajectories from 2004 to 2010, and participants were screened for RA by self-reported physician diagnosis in the subsequent four waves (2010-2018). Cox proportional hazards model calculated hazard ratios (HR). RESULTS: Trajectories of depressive symptoms, physical activity, and multimorbidity status were all associated with the risk of RA. Specifically, keeping a low trajectories (HR = 0.649, 95%CI = 0.533-0.790) or maintaining a moderate rating trajectories (HR = 0.798, 95%CI = 0.644-0.988) for depressive reduced the risk of RA. For physical activity, both high and descending trajectories (HR = 1.456, 95%CI = 1.170-1.812) and high and rising trajectories (HR = 1.244, 95%CI = 1.016-1.522) increased the risk. High multimorbidity trajectories (HR = 1.305, 95%CI = 1.094-1.556) and highest multimorbidity trajectories (HR = 1.393, 95%CI = 1.131-1.715) increased the risk. CONCLUSION: The results suggest that tracking trajectories of depressive symptoms, physical activity, and multiple disease states may be a potential and feasible screening method for identifying those at risk for RA.