Limit daily intake of coffee and artificially sweetened soft drinks to prevent rheumatoid arthritis!!

A study by Ascione S et al., recently published in the journal “Rheumatology”, reported a high risk of rheumatoid arthritis (RA) with consumption of coffee (mostly caffeinated coffee) and artificially sweetened soft drinks, specifically in subjects who never smoked. Moreover, there was a reduced risk of RA with moderate consumption of liquor among smokers. Consumption of tea, alcohol, and sugar-sweetened soft drinks was not associated with risk of RA.

This large, prospective, cohort study including 62,630 women (mean age: 62.5 years) was conducted to investigate the association of specific beverage consumption (coffee, soft drinks, tea, and alcohol) with the risk of RA over a follow-up period of the E3N study (a large prospective cohort study including 98,995 women since 1990). The follow-up duration of the study was 21 years.A validated food-frequency questionnaire was used to evaluate food and beverage consumption. A Cox proportional hazards model was used to assess hazard ratio (HR) and 95% confidence interval (CI). Potential interactions between smoking status and beverage consumption were investigated as smoking is a major risk factor for RA; stratified analyses were conducted as per smoking status (ever-smoker or never-smoker). Sensitivity analyses were conducted in the subgroup of seropositive patients given that the auto-antibody status is a major parameter while analyzing environmental factors related to RA risk.

The primary study results are summarized below:

1. Among the study population, 481 women developed RA (mean age at RA diagnosis: 65.2 years). Among the 35.6% RA cases with known antibody status, 31.8% were seropositive.
2. Increased consumption of total coffee (caffeinated coffee, decaffeinated coffee, and chicory) showed subsequently higher risk of RA (Ptrend = 0.04), particularly among never-smokers (Graphic A).
3. This association was slightly stronger for caffeinated coffee consumption, with a clear increased risk of RA with increased coffee consumption, both in the overall population (Ptrend = 0.04) and never-smokers (Ptrend = 0.005).
4. An increased risk of RA was noted with the consumption of artificially sweetened soft drinks, both in the overall population and never-smokers (Graphic A).
5. There was no risk of RA with the consumption of tea, sugar-sweetened soft drinks, and alcohol.
6. Among ever-smokers, there was a reduced risk of RA with moderate liquor consumption (1–3 glasses/week vs. non-consumers; adjusted HR [aHR]: 0.63, 95% CI 0.43–0.91), while among seropositive RA subgroup, there was a reduced risk of seropositive RA with moderate wine consumption (4–10 glasses/week vs. ≤1 glass/week; aHR: 0.58, 95% CI 0.35–0.97) (Graphic B).

Clinical implications

1. Coffee is a commonly consumed beverage all over the world. Higher consumption of coffee is consistently associated with an increased risk of RA; thus, it is advisable to limit coffee consumption to prevent the onset of RA, especially in individuals at risk of RA such as relatives of patients with RA.
2. This was the first study to report an association between the consumption of artificially sweetened soft drinks and RA risk.
3. Further investigations into the findings of this study may lead to the development of novel mechanistic hypotheses and simple preventive measures for RA.

(Source: Ascione S, Barde F, Artaud F, Nguyen Y, Macdonald C, Mariette X, Boutron-Ruault MC, Salliot C, Seror R. Association between beverage consumption and risk of rheumatoid arthritis: A prospective study from the French E3N Cohort. Rheumatology (Oxford). 2023;62(5):1814-23.)