Alcohol consumers report lower RA disease activity, better outcomes vs. non-drinkers
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Patients with rheumatoid arthritis who consume alcohol report lower baseline disease activity and more favorable 1-year outcomes than those who abstain, according to data published in Arthritis & Rheumatology.
“A large number of studies have reported an inverse relationship between alcohol consumption and rheumatoid arthritis (RA) risk and this concept has been supported by several systematic reviews and meta-analysis,” Lars Alfredsson, PhD, of the institute of environmental medicine at the Karolinska Institute, in Sweden, and colleagues wrote. “Studies on how alcohol consumption effects RA disease progression have been less consistent, although a recent meta-analysis concluded that alcohol consumption is associated with lower disease activity and disability.”
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To investigate the relationship between alcohol consumption and RA, Alfredsson and colleagues analyzed a previously identified cohort from the Epidemiological Investigation of Rheumatoid Arthritis (EIRA) study. Patients with RA were included in the study at the time of diagnosis. The researchers collected lifestyle information via a standard questionnaire, as well baseline data from before therapy initiation. Additionally, patients provided information regarding alcohol consumption, including current and previous habits, at the time of enrollment.
Baseline data, including joint count disease activity score, visual analog scale, patient global assessment scores and health assessment questionnaire scores, were available for 75% of the included patients from the EIRA survey. As such, the current study features 1,228 total patients. Patients reported their swollen and tender joint counts, as well as updated visual analog scale and patient global assessment scores, at 1 year. Additionally, patients estimated fatigue levels and completed a health-related quality of life survey.
According to the researchers, patients who were non-drinkers at baseline demonstrated higher levels of disease activity and higher estimated pain. Similarly, these patients reported higher swollen and tender joint counts, higher levels of pain and fatigue, and lower health-related quality of life, compared with drinkers, at 1 year.
These differences were also present in groups of drinkers and non-drinkers who did not alter their habits following disease onset. Finally, patients who ceased drinking following disease manifestation reported higher levels of disease activity and pain along with lower levels of health-related quality of life at 1 year.
“Participants who consumed alcohol showed less disease activity at baseline and more favorable RA outcomes at 1-year follow-up, compared to non-drinkers,” Alfredsson and colleagues wrote.
“There were no differences in measures of disease activity and disability at baseline between drinkers who continued drinking alcohol and those who later discontinued, whereas those who discontinued alcohol consumption had higher disease activity and disability at 1-year follow-up,” they added. “We believe that the knowledge must be communicated to the scientific community but implementation of this knowledge in the clinics be very individualized, taking both potential advantages and disadvantages of alcohol consumption into account.”
Perspective
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David A. McLain, MD, MACR, FACP, FRCP
Alcohol has a biphasic effect on the immune system. At moderate amounts, it appears to have an anti-inflammatory effect, but at large amounts there is immunosuppression with adverse effects. Clinicians have long observed the association between alcoholism and adverse immune-related effects such as susceptibility to pneumonia, which is three-to-seven times higher in susceptibility and severity in alcoholics.
Recent studies have expanded this association to a greater likelihood of sepsis, acute respiratory stress syndromes, alcoholic liver disease (ALD), hypertension, stroke, type 2 diabetes and certain cancers. Also observed are a higher incidence of postoperative complications, as well as slower recovery from infection and physical trauma with poor wound healing.
The first effect of alcohol is at the gastrointestinal tract, where it alters the gut microbiome. The gut microbiome is involved with maturity and function of the immune system. Alcohol consumption also damages epithelial cells, T cells and neutrophils in the GI system, disrupting gut barrier function and facilitating leakage of microbes into the circulation.
The leakage of microbes activates the innate immune system in the liver and contributes to ALD. Several studies have described a dose-dependent effect of alcohol on human health with light-to-moderate drinkers having a lower risk for all-cause mortality and cardiovascular disease than nondrinkers, while heavy drinkers are at the highest risk.
In the case of the immune system, moderate alcohol consumption is associated with reduced inflammation and improved responses to vaccination, while chronic heavy drinking is associated with lymphopenia, granulocytopenia and an increased risk of both bacterial and viral infections. Alcoholics have also been shown to have an increased incidence of mycobacterium tuberculosis infection. Alcohol has been shown to drive disease progression in chronic viral infections, such as hepatitis C and HIV, and to lower the response to hepatitis B vaccination.
Meanwhile, moderate beer consumption has enhanced the production of T cell cytokines interleukin (IL)-2, IL-4, IL-10 and IFN-γ, and reduced the IFN-γ/IL-10 ratio. IL-4 and IL-10 are anti-inflammatory cytokines. So, the present study showing an effect of alcohol on rheumatoid arthritis makes sense in view of all the research that has been conducted in this area.
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