title: The effect of smoking and alcohol consumption on markers of systemic inflammation, immunoglobulin levels and immune response following pneumococcal vaccination in patients with arthritis.
abstract: BACKGROUND
  The purpose of this research was to study the influence of cigarette smoking and alcohol consumption on immune response to heptavalent pneumococcal conjugate vaccine, immunoglobulin levels (Ig) and markers of systemic inflammation in patients with rheumatoid arthritis (RA) or spondylarthropathy (SpA).
  
  
  METHODS
  In total, 505 patients were vaccinated. Six pre-specified groups were enrolled: RA on methotrexate (MTX) treatment in some cases other disease-modifying antirheumatic drugs (DMARDs) (I); RA on anti-tumour necrosis factor (TNF) as monotherapy (II); RA on anti-TNF+MTX+ possibly other DMARDs (III); SpA on anti-TNF as monotherapy (IV); SpA on anti-TNF+MTX+ possibly other DMARDs (V); and SpA on nonsteroidal anti-inflammatory drugs (NSAIDs) and/or analgesics (VI). Smoking (pack-years) and alcohol consumption (g/week) were calculated from patient questionnaires. Ig, C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) were determined at vaccination. IgG antibodies against serotypes 23F and 6B were measured at vaccination and after four to six weeks using standard ELISA. Immune response (ratio between post- and pre-vaccination antibodies; immune response (IR)) and positive immune response (≥2-fold increase in pre-vaccination antibodies; posIR) were calculated.
  
  
  RESULTS
  Eighty-eight patients (17.4%) were current smokers. Smokers had higher CRP and ESR, lower IgG and lower IR for both serotypes (P between 0.012 and 0.045). RA patients on MTX who smoked ≥1pack-year had lower posIR for both serotypes (P = 0.021; OR 0.29; CI 0.1 to 0.7) compared to never-smokers. Alcohol consumption was associated with lower CRP (P = 0.05) and ESR (P = 0.003) but did not influence IR or Ig levels.
  
  
  CONCLUSIONS
  Smoking predicted impaired immune response to pneumococcal conjugate vaccine in RA patients on MTX. Smokers with arthritis had higher inflammatory markers and lower IgG regardless of diagnosis and treatment. Low to moderate alcohol consumption was related to lower levels of inflammation markers but had no impact on immune response.
  
  
  BACKGROUND
  EudraCT EU 2007-006539-29 and NCT00828997.
authors: Carmen
authors: C
authors: Roseman
authors: Lennart
authors: L
authors: Truedsson
authors: Meliha Crnkic
authors: MC
authors: Kapetanovic
mesh_terms: D000328:Adult; D000428:Alcohol Drinking / Q000009:adverse effects / Q000097:blood* / Q000453:epidemiology; D001172:Arthritis, Rheumatoid / Q000097:blood* / Q000453:epidemiology; D015415:Biomarkers / Q000097:blood; D005260:Female; D000069443:Heptavalent Pneumococcal Conjugate Vaccine; D006801:Humans; D007111:Immunity, Cellular / Q000502:physiology; D007074:Immunoglobulin G / Q000097:blood*; D018836:Inflammation Mediators / Q000097:blood*; D008297:Male; D022242:Pneumococcal Vaccines / Q000009:adverse effects / Q000627:therapeutic use*; D012907:Smoking / Q000009:adverse effects / Q000097:blood* / Q000453:epidemiology
chemical_list: D015415:Biomarkers; D000069443:Heptavalent Pneumococcal Conjugate Vaccine; D007074:Immunoglobulin G; D018836:Inflammation Mediators; D022242:Pneumococcal Vaccines