Could body piercing be a cause of rheumatoid arthritis?

Rheumatoid arthritis (RA) can be a chronic disabling condition despite modern immunosuppressive treatments. Better understanding of its aetiology is key to prevention and despite advances in immunogenetic knowledge the environmental triggers of RA remain uncertain. Following exploration of literature pertaining to the epidemiology and immunopathology of RA, the plausibility of a hypothesis that body piercing might have a causal role is presented. Indigenous North American (INA) populations exhibit markedly raised prevalence rates of RA and often have cultural traditions that involve body piercing in a variety of forms. Historical and archaeological evidence of early RA has consistency in timing with evidence of early human body piercing. The incidence of RA in the UK has increased in recent decades in parallel with an increase in frequency and diversity of body piercing behaviour. Body piercing is a form of somatic trauma resulting in a piercing cavity that houses a foreign object (jewellery) with hypothetical potential to stimulate autoreactive immunological processes. If the pierced tissue is mucosa there is potential for dysbiosis and breakdown in tolerance to modified proteins, thought to be an important early event in RA development. Piercing of cartilage has potential to cause autoreactivity to type II collagen and RA. A carefully designed case-control study might either refute or substantiate this hypothesis which could have significant implications for RA prevention.