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1624 - Prevalence of Alcohol Consumption Among Rheumatoid Arthritis (RA) Patients On Methotrexate (MTX) and Impact On Liver Function Tests
Tuesday, October 20, 2009: 9:00 AM - 11:00 AM
Hall D (Pennsylvania Convention Center)
C. Iannaccone, M. Frits, J. Cui, M. E. Weinblatt and N. Shadick, Brigham & Women's Hospital, Boston, MA
Presentation Number: 1624
Poster Board Number: 357
Purpose: There is little data on the prevalence of alcohol consumption among RA patients, especially those taking MTX. The American College of Rheumatology (ACR) guidelines state that patients on MTX should limit alcohol intake to 2 drinks or less per month because it can significantly increase the risk of liver damage. This study looks at the prevalence and quantity of alcohol use in RA patients on MTX and evaluates whether alcohol consumption results in elevated liver function tests (LFTs), mainly aspartate transminase (AST) and alanine transminase (ALT).
Method: Eligible subjects are RA patients enrolled in a prospective observational cohort (BRASS). Data on patients’ medication use was obtained from physicians and alcohol use was self-reported in an interview. A general linear model analysis was used to determine the differences between patients who reported drinking more than the ACR recommendations while on MTX (drinkers) versus those who followed the ACR guidelines (abstainers). A mixed model was used to compare the LFTs of patients on MTX who were drinkers versus abstainers evaluating multiple time points for the cohort adjusting for potential confounders.
Results: We examined 738 patients (563 on MTX). Six percent of the MTX users had a diagnosis of diabetes and 23% were obese (BMI>30). Alcohol use was reported by 56% of the patients on MTX (Mn=8 drinks/month) compared to 66% (Mn=17 drinks/month) of patients not on MTX (p=.0004). Of the MTX drinkers, 38% were drinking more than the recommended amount. After adjusting for gender and age, a general linear model showed MTX drinkers tended to have lower BMIs, a shorter disease duration, less pain and better physical function than those who abstained (see table).
Of the patients on MTX, we found no difference in the percentage of drinkers (34%) and abstainers (34%) having at least one abnormal LFT result. Also, the mixed model analysis adjusting for age and gender showed no difference in AST or ALT levels between MTX drinkers compared to abstainers (p=0.5, p=0.3) over time. Furthermore, in a subgroup analysis of those with diabetes and obesity, there was still no difference in AST or ALT levels among MTX drinkers compared to abstainers (p=0.5, p=0.9). Conclusion: Despite warnings of the dangers of drinking alcohol while taking MTX, many patients continue to drink. However, we could find no further evidence that MTX drinkers had higher LFTs overall compared with abstainers. While MTX drinkers tended to report less pain and better physical function further study is necessary to determine the clinical impact of this level of alcohol use among MTX users.
MTX Drinkers vs. Abstainers
≥ 2 drinks/month (±SE)
< 2 drinks/month (±SE)
P-Value
BMI
26.4 ± 0.35
27.7 ± 0.35
0.0015
Disease Duration
11.4 ± 0.73
14.0 ± 0.73
0.0037
Physical Function (MDHAQ)
27.8 ± 1.63
36.1 ± 1.73
<0.0001
Pain Scale (MDHAQ)
30.1 ± 1.8
36.1 ± 1.92
0.0004
Physician Global Scale (0-100)
31.5 ± 1.39
34.3 ± 1.39
0.09
Keywords: alcohol use and methotrexate (MTX)
Disclosure: C. Iannaccone, None; M. Frits, None; J. Cui, Biogen Idec, 2, Crescendo Biosciences, 2 ; M. E. Weinblatt, Biogen/Idec, Crescendo, 2, Biogen/Idec, Crescendo, 5 ; N. Shadick, biogen idec, 2, crescendo biosciences, 2, Amgen, 2, Bristol-Myers Squibb Foundation, 2 .
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