The Impact of Lifestyle Factors and Biomarkers on Patients with Autoimmune Disorders

Abstract

Rheumatoid arthritis (RA) and ankylosing spondylitis (AS) are chronic autoimmune diseases shaped by genetic predisposition and modifiable lifestyle factors. Anti–cyclic citrullinated peptide (anti-CCP) antibodies are central to RA diagnosis, but their relevance in AS remains unclear. This study investigates the impact of BMI, stress, and other lifestyle variables on anti-CCP levels in a Georgian cohort, highlighting potential mechanisms of stress-induced citrullination in AS. A cross-sectional study was conducted involving 219 Georgian participants diagnosed with RA or AS. Anti-CCP levels were analyzed against BMI, smoking status, physical activity, perceived stress, age, and sex. Statistical significance was assessed using correlation and regression analyses to evaluate lifestyle modulators of systemic inflammation and autoantibody expression. Overweight or obesity (BMI ≥ 25 kg/m²) was prevalent in 71.5% of RA patients (p = 0.0001) and 66.2% of AS patients (p = 0.0497). Most participants were non-smokers (85%, p = 0.0001). Physical activity showed no correlation with anti-CCP levels (p = 0.6415). RA patients were predominantly female (96.7%), with anti-CCP levels increasing with age (p = 0.0001). In AS, elevated anti-CCP levels were rare and primarily observed in younger females aged 35–44 reporting high stress (p = 0.0075). Perceived stress was significantly associated with increased anti-CCP levels in both RA (p = 0.0001) and AS (p = 0.0034). Anti-CCP antibodies remain diagnostically specific for RA but may be elevated in AS under stress. These findings underscore the interplay between metabolic and psychosocial factors in autoimmune disease and support lifestyle assessment in personalized care.