Smoking, alcohol consumption and disease-specific outcomes in rheumatic and musculoskeletal diseases (RMDs) systematic reviews informing the 2021 EULAR recommendations for lifestyle improvements in people with RMDs
BMJ Publishing Group
Background A EULAR taskforce was convened to develop recommendations for lifestyle behaviours in rheumatic and musculoskeletal diseases (RMDs). The aim of this paper was to review the literature on the relationship between smoking and alcohol consumption with regard to RMD-specific outcomes. Methods Two systematic reviews were conducted to identify systematic reviews and meta-analyses, published between 2013 and 2018, related to smoking and that moderate or high alcohol consumption is associated with increased risk of flares in RA and gout. alcohol consumption in seven RMDs: osteoarthritis (OA), rheumatoid arthritis (RA), systemic lupus erythematosus, axial spondyloarthritis (axSpA), psoriatic arthritis (PsA), systemic sclerosis (SSc) and gout. Two additional systematic reviews were performed to identify original longitudinal studies on smoking and alcohol consumption and disease-specific outcomes. Results Nine reviews and 65 original studies on smoking as well as two reviews and 14 original studies on alcohol consumption met the inclusion criteria. While most studies were moderate/poor quality, smoking was significantly associated with poorer outcomes: cardiovascular comorbidity; poorer response to RA treatment; higher disease activity and severity in early RA; axSpA radiographic progression. Results were heterogeneous for OA while there was limited evidence for PsA, SSc and gout. Available studies on alcohol mainly focused on RA, reporting a positive association between alcohol intake and radiographic progression. Five studies assessed alcohol consumption in gout, reporting a significant association between the number and type of alcoholic beverages and the occurrence of flares. Conclusion Current literature supports that smoking has a negative impact on several RMD-specific outcomes and that moderate or high alcohol consumption is associated with increased risk of flares in RA and gout.
Smoking and alcohol consumption are well-established risk factors for many adverse health outcomes in the general population. ► Our study summarised current literature on the association between smoking and alcohol consumption with disease-specific outcomes in seven rheumatic and musculoskeletal diseases (RMDs) and suggests that smoking and alcohol consumption are detrimental to symptoms, function, disease activity, disease progression and occurrence of comorbidities. ► Health professionals should encourage and support people with RMDs to stop smoking and should inform them about the detrimental effects of smoking and alcohol consumption. ► More studies assessing the effectiveness of interventions on smoking cessation and alcohol consumption reduction on disease-specific outcomes in people with RMDs are required