Chapter 9 ESR and outdoor temperature in RA 110
Wieb Patberg 1985 Paalkoepel, Paterswoldse Meer Ets 14/50
Dual effect of alcohol on pain in
Wiebe R. Patberg, Johannes J. Rasker, and Albert van de Wiel
Department of Physiology, University of Groningen, The Netherlands
Department of Rheumatology, Twente Hospital, Enschede, The
Department of Internal Medicine, Eemland Hospital, Amersfoort, The
Journal of Rheumatology 1999; 26: 1215
Chapter 10 Alcohol and RA 112
Chapter 10 Alcohol and RA 113
To the Editor:
Due to its analgesic effects, alcohol can diminish joint pain, one of the
symptoms of rheumatoid arthritis (RA). However, both relief from, and
aggravation of, joint pain have been reported from patients with RA in
relation to alcohol use (Bradlow & Mowat 1985, Blaze-Temple et al.
1992). This inconsistency might be explained by a delayed worsening
effect of alcohol on RA pain in addition to short-term alleviation of
Figure 1 Plot of correlation coefficient for the relation between daily alcohol intake and joint pain
score in a patient with RA (: p < 0.001). Pain score data were time shifted from -20 to
+40 days with respect to alcohol intake data.
One of the authors (WRP), a 51-year-old man with RA since 1979 satis-
fying American College of Rheumatology criteria (Arnett et al. 1988),
and with positive rheumatoid factor, quantified his daily joint pain (602
scores) as described earlier (Patberg 1989) for 3 years (1994-1996). Daily
joint pain was found to correlate positively with the daily number (range
-20 -10 0 10 20 30 40
phase shift (days)
correlation coefficient (r)
Chapter 10 Alcohol and RA 114
0-5) of alcoholic beverages taken (885 scores) during the 3 years (Figure
1, at phase shift 0 days). The correlation gradually increases when the
pain score data are shifted back in time with respect to the alcohol data,
reaching a maximum at a phase shift of 8 days (r = 0.22, p < 0.001).
This indicates that alcohol intake is followed by an increase in joint pain
8 days later on the average. It might be argued that this finding is related
to the positive correlation between RA pain and the meteorological
temperature and humidity (Patberg 1989), e.g. as a result of drinking
more beer in summer. However, correlation of the alcohol intake with
these weather factors during 1994-1996 shows a negative relationship,
indicating independent influences of weather and alcohol.
The negative peak (Figure 1, arrow) found at a phase shift of 1 day illus-
trates the analgesic effect of alcohol: alcohol intake in the evening low-
ers the joint pain score determined on the following morning.
Although other constituents of the alcoholic beverages taken (mostly
beer and Dutch gin) may play a role, we consider that it is the alcohol
that affects the pain. The effect of alcohol on the disease itself is unclear.
A lowered production of corticosteroids due to the blunting effect of
alcohol on the ACTH response may play a role. It seems clear, how-
ever, that apart from the short-term analgesic effect, alcohol worsens
joint pain in RA.
Chapter 10 Alcohol and RA 115
Bradlow A, Mowat AG 1985. Alcohol consumption in arthritis patients: clinical and labo-
ratory studies. Ann Rheum Dis 44: 163-168.
Blaze-Temple D, Barrett T, Howat P, Binns CW 1992. Arthritis outpatients: disability,
pain and alcohol use. Aust J Public Health 16: 287-293.
Arnett FC, Edworthy SM, Bloch DA, et al. 1988. The American Rheumatism Association
1987 revised criteria for the classification of rheumatoid arthritis. Arthritis
Rheum 31: 315-324.
Patberg WR 1989. Effect of temperature and humidity on daily pain score in a patient
with rheumatoid arthritis [letter]. Arthritis Rheum 32: 1627-1629.