Rheumatoid Arthritis and Alcohol Consumption: What You Need to Know

Is it safe to drink with RA?

In This Article

You have probably heard that moderate drinkers can decrease their risk for certain illnesses, including heart disease. Some studies on rheumatoid arthritis (RA) have suggested a few drinks a week might reduce the risk for the development of RA, and that RA patients may benefit from a few drinks a week.

However, whether alcohol consumption with RA is safe depends on what medications a person takes for treating RA, as well as how much and how often they are drinking. Further, researchers have not been able to pinpoint any direct or specific evidence on whether alcohol has a negative or positive effect on RA, and if there are any health benefits they are minimal at best.

RA and Alcohol

According to the Arthritis Foundation, rheumatoid arthritis affects around 1.5 million Americans, with women accounting for up 75% of the cases. It is an autoimmune disease where the body’s immune system mistakenly attacks the joints. These attacks cause inflammation in the lining of the joints. Sometimes, RA is severe enough to cause irreversible joint damage.

Light to moderate amount of alcohol may lower the number of cytokines that cause inflammation. However, excess alcohol consumption may also increase inflammation.

People differ in how they respond to alcohol and how consumption of alcohol affects their joint pain and other RA symptoms. For some people, there is a pro-inflammatory effect, and for others drinking alcohol makes them feel lousy.

Research

The current research on the consumption of alcohol for people with RA suggests alcohol may not be as harmful as researchers have thought in the past. However, many of these studies are conflicting.

For example, some studies suggest alcohol consumption has no effect on RA, while others suggest it may improve or worsen the condition, or it may lead to a reduced risk. Therefore, more research is needed to determine the safety and benefit of alcohol consumption for people with RA.

Alcohol Has No Effect

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 RA.

According to the data received, patients with more severe disease were more likely to either stop drinking or less likely to start if they were not drinkers in the past. The researchers suggest current drinkers with a disability and lower quality of life are more likely to quit.

Interestingly, the researchers also found that healthier RA patients were the ones that were consuming beer, wine, or liquor regularly. But they do not think that consumption has anything to do with making RA better. In fact, most people with RA consuming alcohol do it because they are not seeing any adverse reactions in doing so.

Alcohol Has Positive Effects

One 2014 study reported in the Journal of Rheumatology finds that RA patients who drank a small amount of alcohol were reporting a better functional status than those who abstained completely.

The researchers noted that this effect was only observed with the consumption of beer, and not alcohol or other liquors. Further, they did not recommend starting to drink alcohol if you don’t already. Moreover, for some people with RA, it is better to avoid alcohol entirely.

Alcohol Makes RA Worse

Other studies suggest alcohol consumption may actually make RA worse. For example, one 2018 study reported in the Scandinavian Journal of Rheumatology study looked at the effect alcohol had on radiological progression in the hands, wrists, and feet of people with RA. Researchers used periodic X-rays to determine how joint erosion or joint space narrowing (radiological progression) had occurred over time in people with RA.

The Scandinavian study 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.

Alcohol May Reduce RA Risk

Some studies have suggested that alcohol consumption may reduce the risk for the development of RA. The previously mentioned 2014 Brigham and Women’s Hospital study, published in the Journal of Rheumatology, also found that drinking in moderation may reduce the risk for the development of RA.

The women in this study who drank two to four beers a week had an up to 31% decreased risk for RA development compared to women who never drank beer.

The researchers felt the benefit was minimal and warned excessive drinking would be harmful and could potentially lead to an increased risk for RA and/or worsening of RA symptoms.

Moderation Is Key

If you decide to drink, make sure you do so in moderation. 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. 

The NIAAA has determined a standard drink equals:

  • 12 ounces of beer
  • 5 ounces of wine
  • 8 to 9 ounces of malt liquor
  • 1.5 ounces of 80-proof distilled spirits (e.g. whiskey or vodka)

Consuming too much alcohol could lead to dependency or alcohol abuse. Drinking more than two servings a day can increase a person’s risk of other illnesses, including cancer. People with are RA are often instructed by their doctors to not drink alcohol with their medications.

RA Medications

Mixing alcohol with your RA medications has the potential to cause adverse reactions. When alcohol and medications—regardless of the medication­—are mixed, there is the potential for accelerated toxicity to the liver.

Disease-modifying antirheumatic drugs (DMARDs), such as methotrexate and Arava (leflunomide), and biologic DMARDs, can elevate liver enzymes and lead to liver damage. Alcohol can increase the risk of problems with the liver. Research on alcohol consumption in people taking methotrexate finds overconsumption can lead to drug-induced liver injury (hepatotoxicity).

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

If you are consuming alcohol regularly or it is a part of your lifestyle you don’t want to change, talk to your doctor so he or she can consider medication options 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) can also lead to liver damage.

A Word From Verywell

The effects of alcohol on RA are vast and complex, and research consistently shows overconsumption leads to a whole host of health problems. Alcohol in moderation is can be safe, but your doctor is in the best position to advise on whether you can consume alcohol while living with rheumatoid arthritis.

Ask about possible contradictions related to prescribed medications and your overall health. The medications you take generally dictate how safe moderate consumption of alcohol is with RA.

If you decide to consume alcohol, remember that alcohol affects people differently. You should monitor how alcohol affects your RA symptoms. If alcohol consumption is making your symptoms worsen, it is best to not drink alcohol.

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Article Sources

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  1. Arthritis Foundation. What is rheumatoid arthritis? (n.d)

  2. Baker JF, England BR, Mikuls TR, et al. Changes in alcohol use and associations with disease activity, health status, and mortality in rheumatoid arthritis. Arthritis Care & Research. 2019 Mar 20. doi:10.1002/acr.23847

  3. Lu B, Solomon DH, Costenbader KH, et al. Alcohol consumption and risk of incident rheumatoid arthritis in women: a prospective study. Arthritis Rheumatol. 2014 Aug;66(8):1998-2005. doi:10.1002/art.38634

  4. Sageloli F, Quesada JL Fautrel B, et al. Moderate alcohol consumption is associated with increased radiological progression in women, but not in men, with early rheumatoid arthritis: results from the ESPOIR cohort (Étude et Suivi des Polyarthrites Indifférenciées Récentes). Scand J Rheumatol. 2018 Nov;47(6):440-446. doi:10.1080/03009742.2018.1437216

  5. National Institute of Alcohol Abuse and Alcoholism (NIAAA). What is a standard drink? (n.d.)

  6. Kremer JM, Weinblatt ME. Quantifying the hepatotoxic risk of alcohol consumption in patients with rheumatoid arthritis taking methotrexate. Ann Rheum Dis. 2018 Jan;77(1):e4. doi:10.1136/annrheumdis-2017-211632

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