Combining alcohol with any medication carries some risk. So if you’re being treated for rheumatoid arthritis (RA)and want to enjoy a glass of wine — or two — how can you determine if that’s a safe, smart move? The answer: It’s hard to know.
Several previous studies made headlines for concluding that inpeople with RA, moderate alcohol consumption was linked with less severe symptoms and a better quality of life. But according to astudy published in March 2019 in the journalArthritis Care & Research, these benefits may not be directly from the alcohol itself. The study found that people with RA tend not to drink when they don’t feel good, so when they do drink, it’s when their symptoms are already under better control. When adjusting for other factors, alcohol use doesn’t affect RA, suggesting that it does not have a clear benefit. In addition, depending on the type ofRA treatmentyou take, the downsides of drinking can start to outweigh the benefits.
Alcohol, Traditional RA Medications, and Your Liver
The main concern about alcohol and RA is damage to the liver. Bothmethotrexate (Trexall, Rheumatrex)— a disease-modifying antirheumatic drug (DMARD) commonly prescribed to manageRA symptoms— and alcohol can be taxing to this vital organ, and combining the two may compound the problem. But astudy published in March 2017 in the journalAnnals of the Rheumatic Diseases表明这个问题可能不是像年代问题ome experts previously thought. Over the course of three decades, researchers studied nearly 12,000 RA patients who take methotrexate and found that those who consumed fewer than 14 drinks a week while taking the DMARD had no increased risk of liver damage when compared with the teetotalers. But those who consumed more than that were at higher risk of developing serious liver problems.
Other pain relievers, including nonsteroidal anti-inflammatory drugs (NSAIDs), such asibuprofen (Advil, Motrin)andnaproxen (Aleve), also don’t mix well with alcohol. They’re more likely to cause stomach bleeding andulcerswhen alcohol is consumed. Drinking while takingacetaminophen (Tylenol)leaves you more vulnerable to liver trouble, too.
Another problem with drinking alcohol while takingmedication for RAis that alcohol can make it difficult for your physician to assess your tolerance of the drug if you have increased liver enzymes. Your doctor may not be able to determine if it’s the RA drug or the alcohol that’s causing the increase. Even if you don’t drink, your doctor may have you stop your RA medication if your liver enzyme numbers increase, to prevent potential damage to your liver.
Considerations for Newer RA Medications
When it comes to mixing newer RA medications with alcohol, the risks remain unclear, because studies on possible interactions haven’t been conducted. For example, many doctors consider it safe for people who take biologic drugs, such asadalimumab (Humira)oretanercept (Enbrel), to drink in moderation. The manufacturers also indicate that it’s safe. Biologics work on specific pathways in the body that aren’t broken down in the liver, making these drugs less of a risk than RA medications that do affect the liver, according to theNational Institutes of Diabetes and Digestive and Kidney Diseases.
Another newer class of drugs, called Janus kinase inhibitors (JAK inhibitors), also have no known interactions with alcohol. But this class of drugs, which includestofacitinib (Xeljanz),baricitinib (Olumiant), andupadacitinib (Rinvoq), are often prescribed along with methotrexate, meaning it’s still important to limit alcohol to less than 14 drinks per week to avoid liver damage.
Alcohol, RA, and Your Bones
Liver function isn’t the only concern. Beer, wine, and spirits can also lower bone density, an extremely important issue for people with RA who are at risk for developingosteoporosisor already dealing withbone loss and joint pain. Excessive alcohol consumption compromises the strength of the skeleton by interfering with the breakdown and rebuilding of bone tissue. People who have RA are already at greater risk for osteoporosis, and alcohol consumption increases those odds, according to theNational Institutes of Health Osteoporosis and Related Bone Diseases National Resource Center.
