Alcohol May Not Offer Benefit in RA
Alcohol consumption did not appear to offer any benefit to patients with rheumatoid arthritis (RA), according to study findings.
“Physicians should not include moderate alcohol use among dietary recommendations in RA,” Joshua F. Baker, MD, MSCE, an assistant professor of medicine at The Hospital of The University of Pennsylvania and the Veteran's Administration Medical Center in Philadelphia, and lead study author, told Rheumatology Consultant. “There are obvious downsides and no clear benefit.”
Previous research has suggested that individuals with RA who consume alcohol may have better health status. A study by Lu et al1 showed that consuming 5.1–10 g/day of alcohol was associated with significantly lower scores on the Modified Health Assessment Questionnaire, an indication of better function.
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“We are anxious to give our patients dietary and behavioral advice and we might be tempted to suggest moderate alcohol consumption. I was concerned that some of these prior observations might be the result of confounding factors,” Baker said.
Baker and colleagues determined alcohol use of 16,762 participants found in FORWARD—The National Databank for Rheumatic Diseases and RA activity from Patient Activity Scale‐II (PAS‐II) semi-annual surveys. Factors associated with changes in alcohol use were identified and used to determine associations between alcohol use and RA activity and mortality.
A total of 121,280 observations were studied among the participants.
Overall, discontinuation and initiation of alcohol were common among participants who consumed alcohol (8.2%) and those who abstained from alcohol (8.4%).
Higher discontinuation and lower initiation rates were associated with a number of variables including greater disease activity, older age, obesity, and low quality of life.
Participants who consumed alcohol had lower PAS‐II scores and mortality rates in traditional models. However, associations were not observed in marginal structural models. Furthermore, recent changes in alcohol use were not associated with clinically significant subsequent changes in disease activity.
“There were many reasons people changed their habits around alcohol use and changes in the behavior were common,” Baker said. “When we consider all the reasons people have changed their behavior over time, we see that the apparently protective effect of alcohol isn’t convincing.”
Baker added that it may be difficult to clarify the beneficial biological effects of alcohol.
“Unfortunately, a randomized trial is very unlikely to ever happen,” he said.
—Melinda Stevens
References:
- Lu B, Rho YH, Cui J, et al. Associations of smoking and alcohol consumption with disease activity and functional status in rheumatoid arthritis. J Rheumatol. 2014;41(:24-30. https://doi.org/10.3899/jrheum.130074.
- Baker JF, England BR, Mikuls TR, et al. Changes in alcohol use and associations with disease activity, health Status, and mortality in rheumatoid arthritis [published online March 20, 2019]. Arthritis Care Res (Hoboken). https://doi.org/10.1002/acr.23847.