Rheumatoid arthritis (RA) is a chronic autoimmune condition where the body’s immune system mistakenly attacks its own tissues, primarily affecting the lining of the joints. This leads to pain, swelling, stiffness, and potential joint damage over time. RA can also impact other body systems, including the skin, eyes, lungs, and heart. Many individuals with RA wonder how alcohol consumption might affect their condition.
Alcohol’s Impact on RA Symptoms and Disease Activity
The influence of alcohol on rheumatoid arthritis symptoms and overall disease activity is not entirely clear, with research yielding mixed results. Some studies indicate that moderate alcohol consumption may reduce certain inflammatory markers, such as C-reactive protein (CRP), interleukin-6 (IL-6), and tumor necrosis factor-alpha receptor 2 (TNF-alpha receptor 2). This potential anti-inflammatory effect may contribute to a reduced risk of developing RA or lessen symptom severity. A “U-shaped” relationship has been observed, where moderate intake correlates with the lowest levels of inflammation.
However, other research suggests apparent benefits might be due to healthier individuals being more likely to consume alcohol, rather than alcohol directly improving RA. These studies found no significant difference in joint inflammation severity between drinkers and non-drinkers. Conversely, excessive alcohol consumption can increase systemic inflammation. This occurs as alcohol can damage the gut and liver, triggering inflammatory responses that could exacerbate RA symptoms. Alcohol also has broad effects on the immune system, complicating its role in an autoimmune condition.
Alcohol and RA Medications: Understanding Interactions
Combining alcohol with certain rheumatoid arthritis medications can pose significant health risks.
Methotrexate (MTX)
Methotrexate (MTX), a commonly prescribed disease-modifying antirheumatic drug (DMARD), is processed by the liver, as is alcohol. Concurrent use, especially heavy consumption, can significantly increase the risk of liver damage or toxicity. While some studies suggest consuming less than 14 units of alcohol per week might not elevate liver risk in MTX users, many rheumatologists still advise complete avoidance. Regular liver function tests are essential for individuals taking MTX.
Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)
Non-Steroidal Anti-Inflammatory Drugs (NSAIDs), such as ibuprofen and naproxen, are often used to manage RA pain and inflammation. Alcohol can significantly increase the risk of gastrointestinal bleeding and ulcers when taken with NSAIDs. Both NSAIDs and alcohol can irritate the stomach lining, and their combined effect can lead to complications. The risk of stomach bleeding is further amplified in older adults or those also taking corticosteroids.
Biologic and Targeted Synthetic DMARDs
Biologic and targeted synthetic DMARDs, like TNF inhibitors and Janus kinase (JAK) inhibitors, are powerful immunosuppressive medications. While direct interactions with alcohol may be less severe than with MTX or NSAIDs, alcohol can generally compromise the immune system. This increased susceptibility to infections is concerning for individuals on these drugs, as they already face a higher risk of serious infections. JAK inhibitors, including tofacitinib, baricitinib, and upadacitinib, have also been associated with liver enzyme abnormalities and an increased risk of specific infections like herpes zoster.
Corticosteroids
Corticosteroids, such as prednisone, are sometimes used to reduce inflammation in RA. Long-term use of corticosteroids can weaken bones and contribute to osteoporosis. Heavy alcohol consumption is also a known risk factor for reduced bone density, creating a dual concern for individuals taking these medications. Combining them with alcohol adds another layer of risk to bone health.
Guidance for Alcohol Consumption with RA
Consulting a healthcare provider is a primary step before consuming alcohol. Discussing alcohol use with a rheumatologist or other healthcare professional is crucial, especially when taking any RA medications. They can provide personalized advice based on individual health status, disease activity, and current treatment plan.
For those cleared by their doctor to consume alcohol, moderation is generally advised. Moderate drinking is defined by health guidelines as up to one drink per day for women and up to two drinks per day for men. If consuming alcohol, it is beneficial to spread units throughout the week rather than consuming them all in one sitting, which can strain the liver. Individuals should also pay close attention to how alcohol affects their symptoms and overall well-being, recognizing any triggers or adverse reactions.
For many individuals with RA, particularly those on specific medications, avoiding alcohol altogether remains the safest approach to minimize risks and support long-term health. Individuals who do not currently drink should not start consuming alcohol for any perceived health benefits related to RA.