酒精对类风湿关节炎影像学进展的影响。

The effect of alcohol on radiographic progression in rheumatoid arthritis.

作者信息

Nissen M J, Gabay C, Scherer A, Finckh A

机构信息

University Hospital of Geneva, Geneva, Switzerland.

出版信息

Arthritis Rheum. 2010 May;62(5):1265-72. doi: 10.1002/art.27388.

DOI:10.1002/art.27388

PMID:20213811

Abstract

OBJECTIVE

Alcohol consumption reduces the risk of development of rheumatoid arthritis (RA) and significantly attenuates the development of erosive arthritis in animal models. It remains unknown whether alcohol consumption influences joint damage progression in RA. This study was undertaken to compare the rates of radiographic damage progression in alcohol drinkers and nondrinkers in a large prospective cohort of patients with RA.

METHODS

All patients in the population-based Swiss Clinical Quality Management in RA registry database with at least 2 sequential radiographs were included. Joint erosions were assessed in 38 joints in the hands and feet using a validated scoring method. The rate of progression of erosions was analyzed using multivariate regression models for longitudinal data and was adjusted for potential confounders.

RESULTS

The study included 2,908 patients with RA with a mean of 4 sequential radiographs and 3.9 years of followup. A trend toward reduced radiographic progression existed in drinkers compared with nondrinkers, with a mean rate of erosive progression of 0.99% (95% confidence interval [95% CI] 0.89-1.09) and 1.13% (95% CI 1.01-1.26) at 1 year, respectively. Alcohol consumption displayed a J-shaped dose-response effect, with a more favorable evolution in occasional consumers (P = 0.01) and daily consumers (P = 0.001) as compared with nondrinkers, while heavy drinkers demonstrated worse radiographic evolution (P = 0.0001). We found significant effect modification by sex, with male drinkers displaying significantly less erosive progression compared with male nondrinkers (mean 0.86% [95% CI 0.70-1.03] versus 1.35% [95% CI 1.02-1.67]; P = 0.007).

CONCLUSION

Our findings indicate a trend toward reduced radiographic progression in alcohol drinkers compared with nondrinkers, specifically in occasional and daily alcohol consumers. In particular, male patients with RA who consume alcohol demonstrate less radiographic progression than do male nondrinkers.

摘要

目的

饮酒可降低类风湿关节炎（RA）的发病风险，并显著减轻动物模型中侵蚀性关节炎的发展。饮酒是否会影响RA患者关节损伤的进展尚不清楚。本研究旨在比较一大群RA患者中饮酒者和不饮酒者的影像学损伤进展率。

方法

纳入基于人群的瑞士RA临床质量管理登记数据库中所有至少有2次连续X线片的患者。使用经过验证的评分方法对手和足部的38个关节进行关节侵蚀评估。使用纵向数据的多变量回归模型分析侵蚀进展率，并对潜在混杂因素进行校正。

结果

该研究纳入了2908例RA患者，平均有4次连续X线片，随访3.9年。与不饮酒者相比，饮酒者的影像学进展有降低趋势，1年时侵蚀进展的平均速率分别为0.99%（95%置信区间[95%CI]0.89 - 1.09）和1.13%（95%CI 1.01 - 1.26）。饮酒呈现J形剂量反应效应，与不饮酒者相比，偶尔饮酒者（P = 0.01）和每日饮酒者（P = 0.001）的病情进展更有利，而大量饮酒者的影像学进展更差（P = 0.0001）。我们发现存在性别对效应的显著修饰作用，男性饮酒者的侵蚀进展明显低于男性不饮酒者（平均0.86%[95%CI 0.70 - 1.03]对1.35%[95%CI 1.02 - 1.67]；P = 0.007）。