Changes in Alcohol Use and Associations With Disease Activity, Health Status, and Mortality in Rheumatoid Arthritis

Abstract

Objective Better disease activity and quality of life have been observed among patients with rheumatoid arthritis (RA) who drink alcohol. This association might be explained by reverse causality. We undertook this study to identify predictors of change in alcohol use and to evaluate independent associations between alcohol use and RA activity and mortality. Methods Participants in Forward, The National Databank for Rheumatic Diseases, were asked about alcohol use (any versus none), and disease activity was collected through the Patient Activity Scale–II (PAS‐II) on semiannual surveys. We identified factors associated with changes in alcohol use and determined associations between alcohol use and disease activity and mortality using linear and logistic regression models, Cox proportional hazards models, and marginal structural models. Results A total of 121,280 observations were studied among 16,762 unique participants. Discontinuation and initiation of alcohol were common among drinkers and abstainers (8.2% and 9.2% of observations, respectively). Greater discontinuation and less initiation were observed with greater disease activity, older age, female sex, nonwhite race, obesity, greater comorbidity, low quality of life, low educational level, low income, and work disability. While alcohol users had lower PAS‐II (β = –0.15 [95% confidence interval (95% CI) –0.18, –0.11], P < 0.001) and a lower mortality (odds ratio 0.87 [95% CI 0.76, 0.98], P = 0.03) in traditional models, associations were not seen in marginal structural models. Conclusion Higher disease activity, disability, comorbidity, and poor quality of life contribute to reductions in alcohol use. Active use and changes in use were not associated with disease activity or mortality when adjusting for confounding, suggesting no clear benefit of alcohol consumption in RA.

Alcohol as friend or foe in autoimmune diseases: a role for gut microbiome?

“…Similar to thyroid disease, diabetes and SLE, multiple epidemiological studies and several mechanistic studies support the protective role of light to moderate alcohol in RA in a J- or U-shaped dose-dependent manner 8 , 15 , 45–54 ( Table 1 ). In a meta-analysis study, both men and women had a reduction in RA risk over 10 years, with women experiencing the highest risk reduction.…”

Change in dietary inflammatory index score is associated with control of long-term rheumatoid arthritis disease activity in a Japanese cohort: the TOMORROW study

“…For E-DII, the item was shown to have decreased in 2017 compared to 2011 (ΔE-DII score negative). Since it has been reported that alcohol consumption may affect disease activity [ 27 ], we also investigated the effect of alcohol consumption instead of E-DII as an item. P values less than 0.05 (2-tailed) were considered statistically significant.…”

Etiologies of Rheumatoid Arthritis: Update on Mucosal, Genetic, and Cellular Pathogenesis

“…Indeed, some early studies showed that fish [ 32 ], omega-3 fatty acids [ 33 ], and modest alcohol consumption [ 34 ] all decreased risk of RA. However, recent studies have dampened early enthusiasm that specific foods may potentiate or protect against RA, showing no association with fish [ 35 ], alcohol [ 36 ], coffee [ 37 ], meat [ 38 ], or dairy products [ 38 ]. A study within the Studies of Etiology of RA (SERA) cohort found one potential reason for discordant results.…”