The effect of alcohol consumption on clinical outcomes and structural damage in patients with axial spondyloarthritis: A systematic literature review and meta-analysis

Evelyne Gendron; Sinead Maguire; Melanie Anderson; Sindhu R Johnson; Robert D Inman; Nigil Haroon

doi:10.1016/j.jbspin.2024.105794

The effect of alcohol consumption on clinical outcomes and structural damage in patients with axial spondyloarthritis: A systematic literature review and meta-analysis

Joint Bone Spine. 2025 Jan;92(1):105794. doi: 10.1016/j.jbspin.2024.105794. Epub 2024 Oct 24.

Authors

Evelyne Gendron¹, Sinead Maguire², Melanie Anderson³, Sindhu R Johnson⁴, Robert D Inman⁵, Nigil Haroon⁵

Affiliations

¹ Schroeder Arthritis Institute, Division of Rheumatology, Toronto Western Hospital, University of Toronto, 399 Bathurst Street, Toronto, ON M5T2S8, Canada. Electronic address: evelyne.gendron.1@ulaval.ca.
² Schroeder Arthritis Institute, Division of Rheumatology, Toronto Western Hospital, University of Toronto, 399 Bathurst Street, Toronto, ON M5T2S8, Canada.
³ The Institute for Education Research, Library and Information Services, University Health Network, 222 St. Patrick Street, Toronto, ON M5T 1V4, Canada.
⁴ Schroeder Arthritis Institute, Division of Rheumatology, Toronto Western Hospital, University of Toronto, 399 Bathurst Street, Toronto, ON M5T2S8, Canada; Division of Rheumatology, Department of Medicine, Mount Sinai Hospital, 60 Murray Street, 2nd Floor, Toronto, ON M5T 3L9, Canada; Clinical Epidemiology & Health Care Research, Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, Suite 425, Toronto, ON M5T 3M6, Canada.
⁵ Schroeder Arthritis Institute, Division of Rheumatology, Toronto Western Hospital, University of Toronto, 399 Bathurst Street, Toronto, ON M5T2S8, Canada; Krembil Research Institute, University Health Network, University of Toronto, 60 Leonard Avenue, Toronto, ON M5T 0S8, Canada.

PMID: 39461411
DOI: 10.1016/j.jbspin.2024.105794

Abstract

Objective: To systematically review the effects of alcohol consumption (AC) on disease-specific outcomes in axial spondyloarthritis (axSpA).

Methods: A systematic review of observational studies on axSpA and AC was conducted. Multiple electronic databases were searched for keywords. Two investigators reviewed articles to assess for inclusion eligibility. The Joanna Briggs Institute Critical Appraisal checklist was employed to evaluate the risk of bias. Standardized mean differences (SMD) were used to synthesize the data and I² was used to ascertain heterogeneity. Spinal pain, disease activity as measured by Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and Ankylosing Spondylitis Disease Activity Score (ASDAS), and spinal radiographic progression based on the modified Stokes Ankylosing Spondylitis Spinal Score (mSASSS) were examined as outcomes.

Results: Search strategy identified 703 records; 13 articles were assessed for eligibility. Five studies (n=3858) were included. Compared to non-consumers, axSpA patients who consumed alcohol had lower BASDAI (SMD: -0.19, 95% CI: -0.37 to -0.02, I²=72.5%) and lower spinal pain (SMD: -0.17, 95% CI: -0.24 to -0.09, I²=0%). No significant difference was found for ASDAS (SMD: -0.19, 95% CI: -0.39 to 0.00, I²=36%). One cohort study on the spinal radiographic progression indicated greater radiographic progression among consumers (SMD: 0.35, 95% CI: 0.08 to 0.62).

Conclusion: AC appears to be associated with lower disease activity and spinal pain. However, these findings may reflect confounding by sex and smoking. Further longitudinal cohort studies with standardized measures for AC are warranted to assess the direction of alcohol's effect on structural damage progression.

Keywords: Alcohol consumption; Ankylosing spondylitis; Axial spondyloarthritis; Lifestyle habits; Systematic review.

Publication types

Systematic Review
Meta-Analysis

MeSH terms

Adult
Alcohol Drinking* / adverse effects
Alcohol Drinking* / epidemiology
Axial Spondyloarthritis*
Disease Progression
Female
Humans
Male
Observational Studies as Topic
Severity of Illness Index