The relationship between alcohol intake and cellular immune activity in systemic lupus erythematosus may change from inhibitory to stimulatory within 2 months of study: findings from an integrative single-case study

Abstract

Alcoholic beverages such as beer and wine contain several compounds (e.g. ethanol and antioxidants) that potentially counteract inflammatory diseases such as systemic lupus erythematosus (SLE) [1]. However, evidence on the association between alcohol consumption and SLE disease activity is equivocal. While meta-analyses by Wang et al. revealed that alcohol drinking might be protective in SLE [2], their own most recent empirical work did not support this observation [3]. This inconsistency may arise from the inability of conventional group studies to appropriately handle the subjective and temporal qualities characterizing the association between drinking alcohol and physiological response [4]. In order to better deal with complex psychosomatic features, we have developed an integrative research approach based on extensive single-case studies [5]. Using this approach, it was shown in a 40-year-old patient with SLE that daily alcohol consumption was associated with a decline in levels of urinary neopterin, an immune activation marker and indicator of SLE activity [6], within 24 h after intake [5]. In our second integrative single-case study on a 52-year-old woman with SLE, we investigated—among other topics—the dynamic relations between drinking alcohol, emotional states (mental activity, irritation and mood) and urinary neopterin concentrations [7]. In this study, the patient collected her entire urine and filled out questionnaires for 56 days in 12-h intervals (total of 112 consecutive measurements). Urinary neopterin was analyzed applying HPLC. The patient noted type and quantity of alcohol intake, which was then converted into gram alcohol consumed. Emotional states (mental activity, irritation and mood) were determined using the short form of the Eigenschaftsworterliste [8]. Time series analysis consisted of autoregressive moving average modelling—to control for serial dependencies—and adjusted crosscorrelational analysis [9]. Cross-correlational analyses revealed that the effect that moderate alcohol consumption (sparkling wine, wine and schnapps) had on urinary neopterin levels differed depending on which time series period was statistically analyzed, i.e. the period before or the period after the occurrence of an inflammatory event (acute paranasal sinusitis) which took place halfway through the study period (12-h units 45– 54). Before sinusitis occurred (1–44), increases in alcohol intake were paralleled by decreases in urinary neopterin levels (lag0: r=−0.371; p<0.05), whereas after sinusitis (55–112) increases in alcohol consumption were followed by increases in urinary neopterin concentrations with a temporal delay of 12 h (lag1 : r 1⁄4 þ0:308; p<0.05). Analyses further demonstrated that none of the emotional states measured in this study (i.e. mental activity, irritation and mood) interfered with the associations between alcohol consumption and neopterin. This integrative single-case study showed that the relationship between alcohol intake and cellular immune activity in SLE can change from inhibitory to stimulatory C. Schubert (*) Clinic of Medical Psychology, Department of Psychiatry and Psychotherapy, Innsbruck Medical University, Innsbruck, Austria e-mail: christian.schubert@i-med.ac.at