Is it Safe to Drink Alcohol When You Have Rheumatoid Arthritis?

There's some research to support that people with rheumatoid arthritis (RA) might benefit from a few alcoholic drinks a week, and that that level of alcohol consumption might also reduce the risk of developing RA. At the same time, it is possible that drinking could increase inflammation and make RA symptoms worse.

If that seems confusing, it's because it is. Thus far, scientists haven't been able to produce definitive evidence of either a negative or positive effect of alcohol on RA. However, if there are any health benefits, they're likely minimal at best.

Furthermore, people differ in how alcohol consumption affects their joint pain and other RA symptoms. A variety of factors can make this hard to predict, including:

• What RA medications you're taking
• Your sex
• How much you drink
• How often you drink
• Possibly even what type of alcohol you drink

Alcohol, Inflammation, and Your RA

Rheumatoid arthritis is an autoimmune disease in which the body’s immune system mistakenly attacks the joints, causing inflammation. Immune cells called cytokines are involved in the inflammatory process, and excess alcohol consumption may promote higher levels.

The current research on alcohol consumption in people with RA does suggest that alcohol may not be as harmful as researchers used to think. Still, many of these studies conflict with one another and raise concern over related inflammation.

For example, a 2018 study in the Scandinavian Journal of Rheumatology looked at alcohol's effect on joint erosion or joint space narrowing (radiological progression) in the hands, wrists, and feet of people with RA. Researchers used periodic X-rays to track radiological progression over time.

They found that even moderate alcohol consumption could lead to an increase in radiological progression in women with RA. Interestingly, the opposite was true for men with RA.

Research on Potential Benefits

Just as there is evidence suggesting that moderate to excess alcohol consumption may negatively affect RA, there is other research indicating that light to moderate alcohol intake may lower the level of cytokines—and, thus, inflammation.

A 2014 study reported in the Journal of Rheumatology found that RA participants who drank a small amount of alcohol reported better functional status than those who abstained completely. Researchers noted that this effect was only observed with the consumption of beer, not other types of alcohol. They don't recommend starting to drink alcohol if you don’t already, though.

This study also found that drinking in moderation may reduce your risk of developing RA. The women in this study who drank between two and four beers a week had up to a 31% lower risk of RA compared to women who never drank beer.

Importantly, the researchers felt the benefit of moderate beer consumption on the risk of developing RA was minimal and warned that excessive drinking could potentially lead to an increased risk for RA and/or worsening of RA symptoms.

One 2019 study published in the journal Arthritis Care & Research looked at whether there was any connection between alcohol consumption and RA symptoms. The researchers relied on a semi-annual survey of up to 17,000 people with the disease.

In people with more severe RA, the data showed a greater tendency to either stop drinking or to not ever start drinking. The researchers interpreted that to mean participants with a lower quality of life due to their disease are more likely to avoid alcohol.

On the other hand, healthier people with RA tended to drink beer, wine, or liquor regularly. That doesn't mean the alcohol had an impact of the disease itself; it's more likely, according to researchers, that healthier people continued drinking because they didn't perceive it as making their symptoms worse.

Medication Interactions

Whether or not to consume alcohol when you have RA hinges not just only on its impact on your symptoms, but on what medications you are taking.

On their own, disease-modifying antirheumatic drugs (DMARDs), such as methotrexate, Arava (leflunomide), and biologics, can elevate liver enzymes and lead to liver damage.

Alcohol can increase the risk of liver problems. Research on alcohol consumption in people taking methotrexate finds over consumption can lead to drug-induced liver injury (hepatotoxicity).

If you are taking methotrexate, it is a good idea to talk to your healthcare provider about how much alcohol is safe to drink while taking this medication. Your practitioner will likely advise you based on medication dosage and the amount of alcohol you're consuming.

If you drink alcohol regularly and want to continue, make sure your healthcare provider knows as well. They may want to consider medications other than methotrexate for treating your RA.

Other medications for treating RA, including nonsteroidal anti-inflammatory drugs (NSAIDs)—both prescription and over-the-counter­—should not be taken with alcohol. Drinking alcohol with these types of drugs can increase the risk for stomach bleeding.

Tylenol (acetaminophen) in combination with alcohol can also lead to liver damage. Opioid painkillers such as Vicodin (hydrocodone acetaminophen) should never be combined with alcohol.

The Right Choice for You

The impact alcohol has on RA symptoms is highly variable from one person to the next. If you and your healthcare provider decide it's safe for you to drink, moderation is key to avoiding negative impacts on not only your RA but your overall health.

According to the National Institute of Alcohol Abuse and Alcoholism (NIAAA), moderate drinking is defined as no more than one drink (serving) daily for women and two drinks daily for men.  

 A serving differs based on the type of alcohol you are drinking. 

A Word From Verywell

The effects of alcohol on RA are vast and complex, and research consistently shows that overconsumption leads to a whole host of health problems. Alcohol in moderation can be safe for some people, but be sure you discuss this with your healthcare provider and follow their advice.

If you decide to consume alcohol, remember that it affects people differently. You should monitor how alcohol affects your RA symptoms and, if it makes them worse, consider cutting back or stopping.