Thursday, April 15, 2010

Does Moderate Alcohol Drinking Benefit Arthritis?

In The NewsPast research studies have suggested that moderate alcohol drinkers have a lower risk of developing rheumatoid arthritis (RA), and now new findings link such imbibing to a slower progression of the joint disease, particularly in men. However, this should not be viewed as an endorsement of alcohol consumption as either a preventative or remedial therapy.

According to a recent report by Reuters Health [Norton 2010], researchers in Switzerland found that light-to-moderate drinkers showed a slower progression of joint damage due to RA than nondrinkers. The findings, presented in the journal Arthritis & Rheumatism, were based on 2,908 Swiss adults who were part of a national database on RA patients [Nissen et al. 2010]. All had at least 2 sets of X-rays of their hands and feet over time, assessing erosions in 38 joints, and had been followed for an average of 4 years. Overall, 37% said they were nondrinkers at the outset, while the rest drank at least sometimes.

The researchers found that both occasional drinkers and those who drank once per day generally had less joint damage progression over time than nondrinkers. The drinking habits remained associated with RA progression even when the researchers controlled for such factors as age, RA medication use, smoking, and the length of time each patient had the disease. However, for unknown reasons, the relationship between drinking and joint damage progression was significantly stronger in men than women (p=0.007). One possibility is the overall difference in alcohol "dose" between men and women; 27% of men drank once per day compared with only 14% of women drinkers.

COMMENT: The validity of past research purporting to demonstrate benefits of alcohol consumption — such as for preventing heart disease and ameliorating other disorders — has often been suspect. Among other concerns, biases due to sponsorship of such research by beverage industry organizations and poor definitions of “optimal” alcohol consumption have been problematic. This current study was funded by the Swiss National Science Foundation, so a funding bias is not evident, but the “dose” of alcohol that is most advantageous for slowing RA progression is rather vague. Once-daily drinking appeared to convey some benefits but these were not evidenced by improved symptoms or less disability. Perhaps, if the slowed disease progression were maintained over decades it could be clinically meaningful; however, the researchers warn that heavy drinking appears to significantly promote joint inflammation and accelerate disease progression (p=0.0001). Nissen and colleagues convey the usual caveat that more research is needed, and they caution that patients with RA should not be encouraged to take up drinking; on the other hand, those who already drink moderately should not necessarily be advised to stop. Still, it is left up to individual practitioners and their patients to decide just what appropriate “moderate drinking” entails — hopefully taking into account how alcohol is frequently misused by persons with pain [see earlier blogpost on this].

> Nissen MJ, Gabay C, Scherer A, Finckh A. The effect of alcohol on radiographic progression in rheumatoid arthritis. Arthritis & Rheumatism. March 8, 2010, online ahead of print [
abstract here].
> Norton A. Moderate drinking may slow arthritis progression. Reuters Health (New York). March 17, 2010 [
article here].
Special thanks to Join Together Online for bringing this news item to our attention.