Drinkers at Lower Risk for Rheumatoid Arthritis but Causality Should Not Be Inferred

Alice Goodman

June 22, 2010

June 22, 2010 (Rome, Italy) — Alcohol consumption is associated with a reduced risk for several arthritic conditions, including rheumatoid arthritis, osteoarthritis, and less common types of arthritis, according to study results released here at the European League Against Rheumatism (EULAR) Congress 2010, but researchers caution against any cause-and-effect conclusions.

Previous studies have suggested that alcohol consumption is protective against rheumatoid arthritis. This effect was most pronounced in smokers, who have a higher risk of developing rheumatoid arthritis. Smoking and drinking often go hand in hand, explained study author Diane van der Woude, MD, from Leiden University Medical Center in the Netherlands.

The study showed an association between low alcohol consumption and arthritic conditions, but this is not necessarily cause and effect, Dr. van der Woude cautioned. "There are several explanations. Perhaps people with arthritis don't feel well and don't drink alcohol. Or it is possible that alcohol suppresses inflammation and/or arthritis. We want to be careful about the message from this study. We are not suggesting that drinking alcohol will protect against rheumatoid arthritis."

The study cohort consisted of 997 people from a database at Leiden University Medical Center with a diagnosis of any type of arthritis of less than 2 years' duration. Of these, 651 had rheumatoid arthritis; 273 had reactive arthritis, spondyloarthropathy, or psoriatic arthritis; and 73 had osteoarthritis.

Alcohol consumption was recorded at baseline (units per week), and the effect of alcohol consumption on risk for disease development was analyzed with univariate and multivariate logistic regression. Odds ratios (ORs) and confidence intervals (CIs) were adjusted for age, sex, body mass index, and smoking.

The effect of alcohol consumption was observed across all types of arthritis. Alcohol consumption was associated with a significantly lower risk of developing rheumatoid arthritis (OR, 2.27; 95% CI, I 0.22 - 0.34), osteoarthritis (OR, 0.31; 95% CI, 16.00 - 0.62), spondyloarthropathy (OR, 0.34; 95% CI, 17.00 - 0.67), psoriatic arthritis (OR, 0.38; 95% CI, 0.23 - 0.62), and reactive arthritis (OR, 0.27; 95% CI, 0.14 - 0.52).

Dr. van der Woude's team analyzed the subgroup with rheumatoid arthritis to determine if they derived particular benefit from alcohol consumption. Patients were stratified according to anticitrullinated protein antibody (ACPA) status and then compared with patients who had other forms of arthritis.

The researchers found "a particularly protective effect in ACPA-positive [rheumatoid arthritis] patients" (OR, 0.59; 95% CI, 0.36 - 0.99). However, this did not remain significant after adjustment for erythrocyte sedimentation rate level (OR, 0.63; 95% CI, 0.38 - 1.07).

An inverse relation was observed between the degree of systemic inflammation, measured by erythrocyte sedimentation rate, and the amount of alcohol consumed (P = .001). No dose-response relation was seen between the amount of alcohol consumed and the risk of developing arthritis.

Dr. van der Woude said that she and her colleagues plan to look at the association between alcohol consumption and other inflammatory diseases, including Crohn's disease and inflammatory bowel disease.

"If these patients drink less alcohol than normal people, it still wouldn't show cause and effect," she said. "It would be informative to study arthritic patients in remission and determine their level of alcohol consumption. It may be that once they feel better, they start to drink again."

If that is the case, she continued, "I would be led to believe it is arthritis that causes people to stop drinking."

Commenting on this abstract, EULAR president Paul Emery, MD, professor of rheumatology at Leeds Institute of Molecular Medicine at the University of Leeds, United Kingdom, said: "These are very interesting findings, but we should assert the need for caution in the interpretation of these data. Alcohol should be consumed in moderation, with consideration for local public health recommendations. A number of social and medical problems are associated with increased use of alcohol; therefore, any positive implications of its use must be understood within the wider health context."

Dr. van der Woude and Dr. Emery have disclosed no relevant financial relationships.

European League Against Rheumatism (EULAR) Congress 2010: Abstract AB0179, accepted for publication only. June 16, 2010.


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