Last Call for Alcohol in Rheumatoid Arthritis

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Key points
• Moderate alcohol consumption is associated with less systemic inflammation and lower C reactive protein (CRP) levels.

• Moderate alcohol consumption has been linked to a lower risk of developing rheumatoid arthritis (RA).

• Moderate alcohol consumption is not associated with local joint inflammation or the number of swollen joints in RA.

• The effects of alcohol in RA appear systemic rather than localized to the joints.

Background
Studies have shown that alcohol consumption is associated with changes in inflammation. Specifically, it has been shown that having one to two drinks a day results in the lowest levels of CRP-with fewer or more drinks associated with increases in those levels.

Lukas Mangnus and fellow researchers in the Netherlands point out that moderate alcohol consumption has also been shown to decrease the risk of developing RA. While it is known that patients with RA who drink one unit of alcohol per day have lower levels of C reactive protein (CRP) and interleukin 6 and lower erythrocyte sedimentation rates, it is not known what effect this has on joint inflammation or the number of swollen joints in RA.

The researchers sought to determine the effect of alcohol consumption on joint inflammation in patients with RA.

The study
In this cross-sectional study, the researchers looked at patients with early RA as well as healthy volunteers. The Leiden Early Arthritis Clinic, an inception cohort, was used for data subjects, and ultimately 1244 patients were included in the analyses.

The results
• 64% of patients in the study who underwent MRI consumed alcohol at baseline.

• 70% of healthy subjects consumed alcohol at baseline.

• There was no difference between MRI-detected inflammation in patients with RA who drank 1 to 7 drinks per week, 8 to 14 drinks per week, or more than 14 drinks per week.

• There was no difference between MRI-detected inflammation in healthy volunteers who drank 1 to 7 drinks per week, 8 to 14 drinks per week, or more than 14 drinks per week.

• A J-shaped relationship was found between alcohol consumption and CRP levels; those who consumed 1 to 7 drinks per week had the lowest CRP levels, with increasing levels as the number of drinks per week increased (P = .006).

Implications for clinical practice
• Alcohol consumption has no effect on MRI-detected joint inflammation.

• Low to moderate alcohol consumption (defined as 1 to 7 drinks per week) results in the lowest levels of CRP.

• Having 1 to 7 alcoholic drinks a week may reduce the risk of developing RA according to studies cited in this work.

Disclosures:

This work was funded by the Dutch Arthritis Foundation and the Netherlands Organization for Health Research and Development.

References:

Mangnus L, van Steenbergen HW, Nieuwenhuis WP, et al. Moderate use of alcohol is associated with lower levels of C reactive protein but not with less severe joint inflammation: a cross-sectional study in early RA and healthy volunteers. RMD Open. 2018;4:e000577. doi:10.1136/rmdopen-2017-000577