Alcohol and disease activity in axial spondyloarthritis: a cross-sectional study

The objective of this study was to explore associations between alcohol consumption and disease activity in axial spondyloarthritis (axSpA). We conducted a cross-sectional study of axSpA participants meeting the ASAS criteria. Associations between self-reported current alcohol use and disease activity (BASDAI, spinal pain, ASDAS), functional impairment (BASFI), and quality of life were explored using multivariable linear models, adjusting for age, gender, symptom duration, use of TNF inhibition therapy, smoking, deprivation, and anxiety and depression (A&D). Within alcohol drinkers, effect of increased alcohol intake (defined as > 14 units/week) was explored with moderate drinking (<= 14 units/week) as reference. The study cohort comprised 229 axSpA patients and 76% were male with mean age 46.5 years (SD +/- 13.8). Alcohol drinking was reported by 64%, with a median of 6 units per week among drinkers. Compared with non-drinkers, drinkers had lower BASDAI (beta = - 0.83; 95% CI - 1.49, - 0.17), ASDAS (beta = - 0.36; 95% CI - 0.66, - 0.05) and BASFI (beta = - 1.40; 95% CI - 2.12, - 0.68). These associations were in contrast to, and independent of, the detrimental effects of smoking, depression, and deprivation. Subgroup analysis in alcohol drinkers did not reveal significant associations between disease severity and increased alcohol intake. Stratified analyses by smoking revealed that in never-smokers without depression, alcohol was associated with greater reduction in disease activity: BASDAI (beta = - 1.69; 95% CI - 2.93, - 0.45), ASDAS (beta = - 0.60; 95% CI - 1.18, - 0.02). Favourable axSpA disease activity and function were observed in association with alcohol consumption in this cross-sectional study. Longitudinal study is required to explore whether this relationship is due to biological effects of alcohol on disease process or disease-associated behaviour modification.