Gender, Not Alcohol Consumption, is Linked to Remission in Patients With Inflammatory Arthritis

Men with inflammatory arthritis, which includes conditions such as rheumatoid arthritis (RA), psoriatic arthritis (PsA), and ankylosing spondylitis (AS), drink significantly more and have less severe disease activity, but alcohol consumption is not linked to disease remission, according to a study published in BMJ Journals.¹ While alcohol has been previously associated with immune changes and an anti-inflammatory effect that may impact disease activity, investigators discovered that gender had more of an impact on disease activity than alcohol intake did. Rheumatologists should continue to advise their patients to monitor and limit alcohol consumption, despite research that shows habitual use activates anti-inflammatory cytokines that dampen innate immune responses.

“Patients with high alcohol consumption had significantly higher odds ratio (OR) of Disease Activity Score 28 CRP (DAS28-CRP) remission and report significantly lower Health Assessment Questionnaire (HAQ) Scores, both suggesting lower disease activity,” explained investigators. “However, when adjusted for gender, alcohol was no longer related to disease activity. Gender was still predictive of disease activity regardless of alcohol use, suggesting the link between higher-risk drinking and lower disease activity was due to male gender.”

The study analyzed 979 patients with inflammatory arthritis. Within this cohort, 62% had RA, 26.7% had PsA, and 11.2% had AS. Information about demographics (age, gender, diagnosis), alcohol use, medications, smoking history, and disease outcome was taken from patients who had been to a rheumatology clinic between 2010 and 2020. Disease activity based on Patient Global Health Visual Analogue Score, swollen and tender joint count, DAS28-CRP, antibody status, and anti-cyclic citrullinated peptide (ACPA) was also collected. Investigators determined disease activity based on univariate and multivariate linear and binary logistic regressions, Mann-Whitney U tests and one-way analysis of variance with Tukey’s honest significant difference (HSD) test. Patients with a <2.6 DAS28-CRP were considered to be in remission. Additionally, patients with AS and a Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) Score of ≤4 were classified as in remission. Patients reported their alcohol consumption, with the high-risk intake being >14 units per week.

The mean DAS28-CRP (Disease Activity Score 28 - C-reactive protein) in patients with RA and PsA at 1 year was 2.96±1.39, and 64.2% of patients were in remission according to DAS28-CRP and BASDAI scores. Men had an OR of 1.8 (1.1, 2.5) (p=0.034) for alcohol consumption and 6.9 (4.7, 9.1) (p=0.001) for drinking 15 or more drinks per week when compared with women.

Patients with PsA consumed an average of 4 (0-12) units, patients with RA consumed 2 (0-6) units, and patients with AS consumed 6 (2-12) units on average. Male alcohol consumption was 6 (1-12), while women consumed 2 (0-6) units on average. Regardless of alcohol intake, the male gender was significantly associated with remission (OR=6.1 (3.2–11.8), p<0.0001).

Investigators believe several factors impacted increased alcohol consumption in the male cohort, including a significantly higher percentage of men in the AS group compared with the RA group and the AS group was slightly younger. As alcohol consumption is more associated with both younger age and the male gender, this could explain the variations. Further, patients with lower disease activity are more likely to attend social events, which may include alcohol.

The study was strengthened by the detailed description of the large cohort of patients, multivariate analysis, and adjustments for confounders. Investigators used gender-based ORs between high-risk drinkers rather than comparing patients who drink alcohol and those who do not. However, self-reported alcohol consumption may have limited the study as there is a chance that some participants may have under-reported their alcohol intake.

“When controlled for gender, the association with alcohol lost significance. However, when the model was controlled for alcohol, gender remained significantly associated with remission,” concluded investigators. “This study highlights the importance of controlling for gender and other demographic information when assessing the effects of alcohol on disease activity. We suggest alcohol does not have an influence on disease activity, gender does.”

Reference:

Turk M, Murray K, Alammari Y, et al. The effects of alcohol consumption and its associations with disease activity among 979 patients with inflammatory arthritis. RMD Open. 2021;7(2):e001510. doi:10.1136/rmdopen-2020-001510