Joshua F. Baker
Moderate alcohol consumption has been associated with less severe disease activity in rheumatoid arthritis not because of any benefit of alcohol consumption, but because higher disease activity, disability and poor quality of life often lead to reductions in alcohol use, according to recent findings in Arthritis Care & Research.
“The study is important because it calls into question the value of moderate alcohol consumption in patients with rheumatoid arthritis,” Joshua F. Baker, MD, MSCE, of the Philadelphia VA Medical Center, told Healio Rheumatology. “Prior studies hinted that patients with RA who drink alcohol seem to feel better. However, our concern was that this was observed simply because people who do not feel well tend not to drink as much.”
To test this hypothesis and analyze the independent links between alcohol use and RA activity and mortality, Baker and colleagues evaluated patient information in Forward, The National Databank for Rheumatic Diseases from 1999 to 2016. According to the researchers, Forward is a patient-based, multidisease, multipurpose registry and cohort study of rheumatic disease in practices across the United States. Patients included in the cohort complete semi-annual surveys, which include a question regarding alcohol use. Disease activity was assessed using the Patient Activity ScaleII (PASII).
Moderate alcohol use has been associated with less severe disease activity in RA not because of any benefit of alcohol consumption, but because higher disease activity, disability and poor quality of life often lead to reductions in alcohol use, according to findings.
The researchers identified 121,280 observations among 16,762 patients in Forward for their study. They identified factors linked with changes in alcohol consumption, and found associations between alcohol use and disease activity and mortality, using various models, including linear and logistic regression, Cox proportional hazards and marginal structure.
According to the researchers, greater discontinuation and less initiation of alcohol consumption were found in patients with greater disease activity, older age, female sex, nonwhite race, obesity, greater comorbidity, lower quality of life, lower educational, lower income and work disability. In addition, although traditional models show that patients who used alcohol demonstrated lower PASII (beta= –0.15; –0.18 to –0.11) and lower mortality (OR = 0.87; 0.76-0.98), these links were not evident in marginal structural models.
The researchers also found that discontinuation of alcohol use was common among drinkers, with 8.2% of eligible observations including a discontinuation event. The initiation of alcohol use was common among those who abstained, representing 8.4% of eligible observations.
“In basic terms, I hope that this study helps to discourage patients from moderate alcohol use in the hopes of improving their arthritis symptoms and disease outcomes,” Baker said. “Although patients are frequently interested in dietary changes that might help their disease, the evidence does not seem to support the use of alcohol to help reduce the symptoms of arthritis.” – by Jason Laday
Disclosure: Baker reports consulting fees from Bristol Myers Squibb. Please see the study for all other relevant financial disclosures.