Background/Purpose: Previous studies have shown that alcoholic beverage consumption can modify levels of circulating inflammatory cytokines and alter expression of innate immune system receptors. Recognizing these changes, investigators have sought to identify the association of alcohol consumption with rheumatoid arthritis (RA) risk and progression. To date, studies have primarily been limited to patients of European ancestry and have yielded conflicting results. To address this gap of knowledge we sought to investigate alcohol consumption and RA disease progression in African Americans; a historically understudied cohort. Specifically, the aim of our study was to determine if alcohol consumption, stratified by dose, is associated with radiographic disease progression in African Americans during the early stages of RA. 

Methods: RA patients included in the study were participants in the Consortium for the Longitudinal Evaluation of African Americans with Early Rheumatoid Arthritis (CLEAR) registry with < 2 years disease duration from symptom onset. Patients reported the average number of alcoholic beverages consumed per month and a modified Sharp/van der Heijde score was computed to assess disease progression using joint space narrowing and erosion totals in radiographs of the wrists, hands, and feet. Upon visual inspection, a clear natural break with an inflection in the slope was identified at 15 beverages per month. Patients were subsequently categorized into two groups: those consuming < 15 beverages per month versus those consuming ≥ 15 per month. Associations of radiographic disease progression over a one to three year period of observation with alcohol consumption was evaluated using generalized estimating equations adjusting for patient demographics, current RA therapy, anti-CCP, RF-IgM, c-reactive protein, and smoking status.  

Results: There were 166 patients included in the study; 139 reported that they consumed, on average, < 15 alcoholic beverages per month and 27 reported consuming ≥ 15 per month. A “checkmark-shaped” relationship of alcohol consumption and radiographic disease progression was identified and is shown in Figure 1.  In patients consuming ≥ 15 alcoholic beverages per month, alcohol intake was associated with an increased risk of radiographic disease progression (p = 0.017) after multivariate adjustment. There was no evidence of a relationship in those consuming < 15 beverages per month (p = 0.802).

Conclusion: There appears to be a dose-dependent relationship between alcohol use and radiographic disease progression in African Americans with RA. Individuals who consume 15 or more alcoholic beverages per month may have accelerated rates of radiographic joint damage compared to those with lower levels of consumption.

Figure 1. Radiographic disease progression summarized based on the average number of alcoholic beverages consumed per month.