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The risk for cardiovascular diseases and other comorbidities increases with the number of unhealthy lifestyle factors in the general population. However, information on the combined number of unhealthy lifestyle factors in people with rheumatoid arthritis (RA) is scarce. Objectives To study lifestyle factors and the association between disease impact and two or more unhealthy lifestyle factors in two Scandinavian cohorts with RA. Methods We analysed data from two cohorts, Danish ( n  = 566; mean age 61.82 (SD 11.13) years; 72% women) and Swedish ( n  = 955; mean age 66.38 (SD 12.90) years; 73% women). Lifestyle factors (tobacco use, BMI, alcohol consumption and physical activity) were dichotomised as healthy vs. unhealthy (range 0–4 unhealthy factors). The association between disease impact and two or more unhealthy lifestyle factors was analysed using logistic regression. Results Sixty-six percent of Danish and 47% of Swedish respondents reported two or more unhealthy lifestyle factors, most commonly, being overweight/obese and physical inactivity. For Danish participants, two or more unhealthy lifestyle factors were associated with (OR and 95% CI) male gender (1.86; 1.21–2.85), cardiovascular diseases (1.90; 1.28–2.82) and disease duration (0.97; 0.95–0.99). Corresponding findings for the Swedish cohort were male gender (1.42; 1.07–1.89), pain (1.10; 1.04–1.15), fatigue (1.09; 1.04–1.15), physical functioning (1.64; 1.28–2.10) and quality of life (0.35; 0.20–0.60). Conclusion Many patients, most often male, in both cohorts had two or more unhealthy lifestyle factors. The number of unhealthy lifestyle factors indicates a multifaceted relationship with disease impact. Key Points  • This article contributes with new information concerning the proportion of patients with RA who have one or more unhealthy lifestyle factors.  • Every second patient in the two included cohorts reported two or more unhealthy lifestyle factors.  • Two or more unhealthy lifestyle factors were more common in men than in women but were not necessarily associated with measures of disease impact.  • In order to adhere to a healthier lifestyle, a large proportion of the patients need to change more than one lifestyle habit, which entails a challenge for both the patients and the health professionals.

Lifestyle factors in patients with rheumatoid arthritis—a cross-sectional study on two Scandinavian cohorts