‘Surprising’ Link Between Smoking, Alcohol and Peripheral Disease

Patients with severe AxS tend to avoid unhealthy habits, study suggests

Joana Vindeirinho, PhD avatar

by Joana Vindeirinho, PhD |

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Smoking and alcohol consumption are both associated with lower rates of peripheral symptoms in people with spondyloarthritis, which includes ankylosing spondylitis, a new study reports.

The findings were somewhat surprising, researchers noted, as smoking has been linked to a greater risk of developing certain rheumatic diseases, and with more severe disease symptoms.

“We have shown that, surprisingly, among patients with a diagnosis of [spondyloarthritis], smoking and alcohol consumption are associated with a lower prevalence of peripheral manifestations,” researchers wrote.

The study, “Smoking and alcohol consumption are associated with peripheral musculoskeletal involvement in patients with spondyloarthritis (including psoriatic arthritis). Results from the ASAS-PerSpA study,” was published in the journal Seminars in Arthritis and Rheumatism.

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Majority of patients experience peripheral symptoms

Axial spondyloarthritis (AxS) is a group of inflammatory arthritis diseases that mainly affect joints in the spine, pelvis, and chest. Ankylosing spondylitis is a more severe subtype marked by inflammation that mostly affects the joints connecting the pelvis with the base of the spine.

However, the majority of AxS patients also experience peripheral symptoms of the disease, including peripheral arthritis (or joint inflammation in the arms and legs), enthesitis (inflammation in joint regions where tendons and ligaments attach to bones), and dactylitis (inflammation of the joints and tendons in fingers and toes).

Smoking and alcohol have both been linked to more severe symptoms and disease progression in people with AxS. However, this association was mostly observed for main symptoms; for peripheral symptoms, the evidence is less certain.

To address that, a team of researchers in Spain set out to examine how alcohol consumption and smoking affected the peripheral manifestations of these diseases. They drew on data from the global ASAS-PerSpA study, a large observational study tracking peripheral symptoms in AxS patients.

A total of 4,181 patients, included in the study from July 2018 to February 2020, were in the analysis. Eligible participants had a diagnosis of AxS, peripheral spondyloarthritis, or psoriatic arthritis — two other forms of spondyloarthritis — and had provided information about their smoking and alcohol intake.

The researchers investigated possible associations of smoking and alcohol consumption with peripheral arthritis, enthesitis, and dactylitis, as well as with their specific locations in the body.

Overall, people with AxS who had a smoking history reported peripheral symptoms less frequently than those who had never smoked — 38.9% versus 46.6%. In particular, those who smoked were significantly less likely to experience peripheral arthritis and dactylitis, but not enthesitis.

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Prevalence of peripheral symptoms in AxS not associated with alcohol intake

In contrast, the prevalence of any peripheral manifestation was not different between patients who consumed alcohol and those who never did — 40% vs. 40.1%.

While no association was observed between alcohol and peripheral symptoms in AxS patients, people with peripheral spondyloarthritis or psoriatic arthritis who consumed alcohol were less likely to have peripheral arthritis and enthesitis, the team found.

Smoking was also linked to lower rates of arthritis in patients with psoriatic arthritis.

However, no association was found between smoking and alcohol and the specific locations of the peripheral manifestations in any patient group.

Although surprising, the notion that alcohol and smoking may reduce the frequency of peripheral symptoms is supported by previous studies that showed similar associations. A potential explanation for this finding, however, may be that “patients with more severe disease tend to avoid toxic habits,” the team wrote.

“Studies on the molecular mechanisms underlying this relationship would undoubtedly be necessary,” the researchers added.

Beyond molecular analyses, longitudinal studies that follow a large group of patients over time are also needed, which could allow the cause-and-effect relationship of smoking and alcohol in patients with spondyloarthritis to be properly investigated.