To the best of our knowledge, there has been no report
concerning the alcohol consumption properties of
living rheumatic patients. Myllykangas-Luosujärvi et
al.
3,4 previously reported the results of two different
investigations performed using a retrospective analysis
of the medical records of deceased patients via the
National Insurance Act of Finland. According to these
reports, the relative risk of mortality due to alcoholrelated
events was higher for AS patients and lower for
RA patients than for the general population for both
genders. However, no connection was assumed in these
studies with regard to the rate of alcohol consumption
in living patients since that was not the intent of the
research.
It is a known fact that men in our country
consume more alcohol than women. The Ministry of
Health has reported that the rate of women aged 15
years and older who do not consume alcohol was 93%.
This rate was 63.9% for men and 78.7% for the total
population.11 In our study, the rate of “alcohol nonconsumers”
was 79.6% and 49.2% for women and men,
respectively. The rate for having first-degree relatives
who have a habit of consuming alocohol was higher
among females in our study. This is not surprising
because most of the relatives mentioned as “alcohol
consumers” were males (fathers, brothers, husbands,
etc). One of the inclusion criteria for our study was
that the subjects had to be over 18-years-old or older. The age limits in our investigation together with the
information reported by the Ministry of Health may
offer reasons for the discrepancy regarding the higher
rate among females. We did not have opportunity to
compare these figures via age-adjusted correction, but
we can hypothesize that these figures should be near
each other. Therefore, we can assume that the results
for our study population are similar to the general
population, but more research would be needed
to confirm this. Most people in our country are
Muslims, and alcohol intake is forbidden by Islamic
rules; therefore drinking alcohol is not considered
to be a custom for social interactions in the Turkish
population. The high rate of “alcohol non-consumers”
reported is not surprising. The honesty of the subjects
while answering the requested questions may be an
important factor in determining the results, but it is
impossible to reveal such an effect objectively.
In our study, the alcohol consumption rates for AS
and RA patients, without considering gender difference,
were 36.9% and 23.0%, respectively. The alcohol
consumption rate of the latter group was statistically
lower than that of the healthy controls, and the rates
between the AS and control groups had no statistical
significance. An earlier study had revealed a lower rate
of alcohol consumption among women with arthritis.2
The lower rate of alcohol consumed in the RA group may
be explained by the relative female dominance of the
subjects within this group, but no statistical difference
in alcohol consumption between genders was seen in
this group. On the other hand, there was a significant
difference between genders with the AS patients. The
alcohol consumption habits of the RA and AS groups
were statistically different (p=0.042). In previous
reports, there were possible explanations for the similar
conditions. The low incidence of alcohol-related deaths
among RA patients was interpreted as a reflection
that alcohol consumption leads to protection against
disease.3 The association of alcohol consumption and
the reduced risk and severity of RA was mentioned
in several other reports.12-14 The mechanism of this
protective effect is still unclear; however, it is not logical
to draw such a conclusion through the finding of
“low incidence of alcohol consumption among RA
patients”. Our investigation did not seek to explore the
attributed risk of alcohol consumption to having RA or
try to determine its severity when present. The other
suggested explanation for the low incidence of alcoholassociated
events in RA patients was the reduction
of patients after being diagnosed of RA. One of the
suggested reasons for this was increased joint pain associated with alcohol consumption.3 However, in our
study, we had no patient that reported an increase in
pain after consuming alcohol.
The rate of alcohol consumption in the AS group in
our study was higher than the RA group, but it did not
differ statistically from the control group. Our results
demonstrated that the “alcohol-consumers” in the AS
and control groups were predominantly males, so the
higher rates of alcohol consumption relative to the RA
group may be partly explained by this predominance.
Myllykangas-Luosujärvi et al.4 suggested two possible
explanations for the association of alcohol-related
events in AS patients. The first possibility was the
aggrevation of pain in AS patients due to lifestyle
alterations in addition to alcohol consumption or
other addiction such as smoking. The second possible
reason was the probability that the emotional problems
created by the pain of AS may cause so-called “relief
drinking”. Sırmalı et al.15 defined AS as a perturbing
psychosocial concern and suggested the necessity of
using the psychotherapeutic approach to deter AS
patients from consuming alcohol and smoking. In
our study, only two patients with AS confessed that
they had used alcohol for analgesia. Nevertheless,
since there is no report in favor of the protective role
of alcohol regarding AS, preventive measures against
alcohol consumption should be considered.
We used the MAST as a screening test to determine
whether our subjects had a problem with alcohol
consumption. Actually, this method is an old and
difficult one to apply. Nevertheless, most of our
subjects successfully completed the test. According
to our results, the mean MAST score was statistically
higher in the control group than in the other two
groups. By categorizing the MAST score we found that
only four subjects were within the highest category
(MAST score of 10 or more). These four subjects
were males and belonged to the control group. In
general, higher MAST scores represent an increased
risk for problematic alcohol drinking.9 Our analysis
revealed that our subjects generally had a low risk
for alcohol-related events. Hence, our results are
in contrast to those of Myllykangas-Luosujärvi et
al.4 As mentioned previously, the results our study
depended on the honesty of our subjects when filling
out the questionnaire, and this subjectivity can not be
accounted for by any objective method.
This study was only a cross-sectional investigation
and was designed in order to define the alcohol
consumption habits of patients with inflammatory rheumatic disease. Our research was not concerned
with the other possible factors which may have had a
determining role on the alcohol consumption habits
of the individuals. Incidentally, we found an inverse
relationship between the probability of “problematic
alcohol consumption” and the educational status
of our subjects. The psychological profile of the
participants, their total financial income, and their
ability to obtain alcohol are just some of the potential
determining factors for alcohol consumption, and
further research is needed to make any conclusions
regarding their exact effect. There were no questions
concerning these factors in our study, which was
a major flaw. On the other hand, our study was
comprised of more than 300 people; hence, the sheer
numbers of participants justifies the purpose of our
study. The final results of this investigation, some of
which are interesting and different from the general
population, make our study valuable. The higher
number of AS patients who have a habit of alcohol
consumption should especially be kept in mind. All
of the “problematic drinkers” belonged to the control
group, and their numbers were very low.
In conclusion, we found that alcohol consumption
was low in our rheumatic patients. These findings
should be interpreted with caution because many of the
drugs used for the treatment of rheumatic diseases are
potentially hepatotoxic. Our results need to be verified
by further studies, and these should be designed in
a manner so as to explore the other possible factors
which may determine alcohol consumption properties
and their consequences on the health status of patients.
Declaration of conflicting interests
The authors declared no conflicts of interest with
respect to the authorship and/or publication of this
article.
Funding
The authors received no financial support for the
research and/or authorship of this article.
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