Letter

Alcohol consumption protects against arthritis development in seropositive arthralgia patients Patients with arthralgia and auto-antibodies such as anticitrul-linated protein antibodies and/or IgM-rheumatoid factor (sero-positive) are at risk for developing rheumatoid arthritis (RA).1 RA is associated with lower alcohol intake, suggesting that alcohol consumption is protective for the development of RA.2–5 The proposed mechanism for this effect is that alcohol is immu-nosuppressive, possibly via intrinsic corticosteroid production. In animal models several immunosuppressive effects have been found and in humans alcohol intake also causes immune modulation.6 However, cross-sectional studies on the effect of alcohol on RA risk are hampered by multiple confounding fac-tors. For instance, pain, psychological distress and the use o