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. 2022 Mar;8(1):e002170.
doi: 10.1136/rmdopen-2021-002170.

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

Maud Wieczorek #  1   2 , James Martin Gwinnutt #  3 , Maxime Ransay-Colle #  2 , Andra Balanescu  4 , Heike Bischoff-Ferrari  1   5   6 , Annelies Boonen  7   8 , Giulio Cavalli  9 , Savia de Souza  10 , Annette de Thurah  11   12 , Thomas Ernst Dorner  13   14   15 , Rikke Helene Moe  16 , Polina Putrik  7   8 , Javier Rodríguez-Carrio  17   18 , Lucía Silva-Fernández  19 , Tanja A Stamm  20   21 , Karen Walker-Bone  22 , Joep Welling  23 , Mirjana Zlatkovic-Svenda  24   25 , Suzanne Mm Verstappen #  26   22   27 , Francis Guillemin #  2   28
Affiliations

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

Maud Wieczorek et al. RMD Open. 2022 Mar.

Abstract

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 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.

Keywords: Epidemiology; Patient Reported Outcome Measures; Smoking.

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Conflict of interest statement

Competing interests: None declared.

References

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