July 10, 2012

expert reaction to study of alcohol consumption and rheumatoid arthritis risk

A study in the BMJ indicated that moderate consumption of alcohol by women for at least 10 years is associated with a reduced risk of developing rheumatoid arthritis compared to non-drinkers. A before the headlines analysis was also sent out.

Professor Patrick Venables, Professor of Viral Immunorheumatology, Imperial College London, said:

“This is a sound study but the findings are not new. the inverse relationship between alcohol consumption and rheumatoid arthritis was first reported in 1990 and confirmed by two large studies in 2009 and 2010 when it really hit the headlines. The protective effect of alcohol in arthritis has also been observed in animal models. The mechanism of this effect is unknown. Therefore this study reports nothing new beyond the effect of quite low alcohol intake (3 units per week) maintaining this benefit.”

Professor Alan Silman, Medical director of Arthritis Research UK, said:

“This study should not be regarded as a directive to binge drink.

“This is a very interesting study that shows that compared to people who drink absolutely no alcohol, people who drink very modest amounts – two to four glasses of alcohol a week – have a degree of protection against developing rheumatoid arthritis. Small amounts of alcohol are also known to be beneficial in reducing the risk of other conditions such as heart disease, also an inflammatory disease, so the study is also telling us something about the mechanism of inflammation.

“However, it’s important to stress that the paper isn’t saying that excessive amounts of alcohol are good for you. And it must be remembered that drinking alcohol in excess can be especially dangerous in rheumatoid arthritis patients who are taking some anti-rheumatoid drugs that may cause liver damage, and anti-inflammatory painkillers which can lead to gastro-intestinal problems, which can be exacerbated by alcohol.”

Additional comments from Arthritis Research UK: Points from the paper: •,This is a very large cohort study (34,141 women aged 54- 89) looking at both the amount of alcohol drunk and the types of drink chosen (wine, beer or spirits). •,The data was adjusted for BMI, educational level (as proxy for social/economic groupings), and number of children, menopause and eating meat and dairy products. •,The risk of developing RA decreased with an intake of 2 to 4 glasses of alcohol per week. •,A long term intake of moderate levels of alcohol (over the 10 years of follow up) halved the risk of developing RA. •,The type of alcohol drunk did not affect the risk level. Limitations: •,There was no way to assess high alcohol intake as there were not enough heavy drinkers in the cohort. •,There was no assessment of family history of RA. Comments: •,The Karolinska Institute is very highly regarded for both genetics and large cohort studies. They have done previous studies in this area, which were reported in the UK media in 2008. •,Scandinavian studies in this area are highly regarded as the countries have excellent health registries of the general population. •,This study agrees with various smaller case studies, but is the first one to look at a large cohort. •,There is good immunological evidence that low levels of alcohol are beneficial both for reducing the risk of RA and heart disease. •,The mouse- based studies suggest that you can reduce TNF and IL-6 (these are both pro-inflammatory molecules implicated in RA) by putting low levels of ethanol in the drinking water. •,However, as a note of caution there is no evidence that drinking more than two to four of glasses a week would be beneficial – obviously we are not advocating binge drinking. •,We also need to take into account treatments. NSAIDs (like aspirin and ibuprofen) can cause GI pain and bleeding that can be exacerbated by alcohol. DMARDs (like methotrexate) can exacerbate liver problems, as can alcohol, so this would be a bad mix. Patients would need advice from a clinician about drinking depending on their medication.
‘Long term alcohol intake and risk of rheumatoid arthritis in women: a population based cohort study’ by Giuseppe, D. et al., published in BMJ on Tuesday 10th July.