This article is more than 5 years old. Information may no longer be current.
Smoking, alcohol affected immune response differently in patients with rheumatoid arthritis
Patients with rheumatoid arthritis who smoked and were treated with methotrexate had an impaired immune response to pneumococcal vaccine, while moderate alcohol consumption had no impact on response in a study.
Five hundred five patients (253 with rheumatoid arthritis [RA]; 252 with spondylarthritis [SpA], including psoriatic arthritis) assigned anti-inflammatory treatments were vaccinated with pneumococcal 7-valent conjugate vaccine. Patients completed questionnaires on smoking and alcohol consumption and were placed into one of six groups based on diagnosis and treatment:
-
RA assigned methotrexate (MTX) and possibly other disease modifying antirheumatic drugs (DMARDs) (n=85)
-
RA assigned anti-tumor necrosis factor (a-TNF) (n=79)
-
RA assigned a-TNF, MTX and possibly other DMARDs (n=89)
-
SpA assigned a-TNF (n=83)
-
SpA assigned a-TNF and MTX (n=83)
-
SpA assigned nonsteroidal anti-inflammatory drugs and/or analgesics (n=86)
Immunoglobulin (Ig) levels, C-reactive protein (CRP) and erythrocyte sedimentation rates (ESR) were tested at vaccination. ELISA was used to measure IgG antibodies against pneumococcal polysaccharide serotypes 23F and 6B at vaccination and after 4 to 6 weeks. Researchers measured immune response (IR) as the ratio between post- and prevaccination antibodies and positive immune response (posIR) as at least a twofold increase in prevaccination antibodies.
Current smokers (88 patients; 64 women) had higher CRP and ESR compared with nonsmokers and lower IgG and IR for both serotypes. Patients with RA assigned MTX who smoked for at least one pack-year (20 cigarettes smoked daily for a year) had lower posIR for both seroytpes compared with those who never smoked.. Three hundred thirty-three patients (65.9%) reported alcohol consumption on a regular basis, with the majority reporting low to moderate alcohol use (≤30 g 100% ethanol daily). Alcohol consumption (more common in men; P<.001) did not influence posIR or Ig levels but was associated with lower CRP (P=.05) and ESR (P=.003).
“Our results contribute to the growing culture of evidence of negative effects of smoking and possible advantages of moderate alcohol drinking in patients with established arthritis,” the researchers concluded.