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

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. (c) 2024 Published by Elsevier Masson SAS on behalf of Soci o<acute accent>t o<acute accent> Fran o<acute accent>aise de Rhumatologie.