Higher levels of disease activity, comorbidities, and disability and poor quality of life contribute to reductions in alcohol use among patients with rheumatoid arthritis (RA), according to results published in Arthritis Care & Research.

Improved disease activity and quality of life have been observed among patients with RA who drink alcohol, an association that might be explained by reverse causality. Therefore, the investigators sought to identify predictors of changes in alcohol consumption and to assess independent links between alcohol use and RA activity/mortality.

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Participants in Forward, the National Databank for Rheumatic Diseases, were asked about alcohol use (any vs none). Data on disease activity were collected through the Patient Activity Scale-II (PAS-II) on semiannual surveys. Comorbidity burden was measured using the Rheumatic Disease Comorbidity Index, a validated quantitative measure of comorbid illnesses. Overall, 121,280 observations were examined among a total of 16,762 unique participants.

The results of the study showed that discontinuation and initiation of alcohol use were common among both drinkers and abstainers (8.2% v 8.4% of observations, respectively). Greater discontinuations and fewer initiations were reported with greater disease activity, female gender, older age, nonwhite race, more comorbidities, obesity, low quality of life, low income, low educational level, and work disability.

Although participants who consumed alcohol had significantly lower PAS-II (β, −0.15; 95% CI, −0.18 to −0.11; P <.001) and significantly lower mortality (odds ratio, 0.87; 95% CI, 0.76-0.98; P =.03) in traditional models, similar associations were not observed in marginal structural models.

Data show that active use and recent changes in alcohol use among patients with RA were not associated with disease activity or mortality when adjusting for confounding factors. The findings from this study refute prior evidence that suggests a beneficial effect of alcohol among patients with RA.


Baker JF, England BR, Mikuls TR, et al. Changes in alcohol use and associations with disease activity, health status, and mortality in rheumatoid arthritis [published online March 20, 2019]. Arthritis Care Res (Hoboken). doi: 10.1002/acr.23847