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.