Several previous studies made headlines for concluding that in people with RA, moderate alcohol consumption was linked with less severe symptoms and a better quality of life. But according to a study published in March 2019 in the journal Arthritis 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 of RA treatment you 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. Both methotrexate (Trexall, Rheumatrex) — a disease-modifying antirheumatic drug (DMARD) commonly prescribed to manage RA symptoms — and alcohol can be taxing to this vital organ, and combining the two may compound the problem. But a study published in March 2017 in the journal Annals of the Rheumatic Diseases suggests this issue may not be as problematic as some 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 as ibuprofen (Advil, Motrin) and naproxen (Aleve), also don’t mix well with alcohol. They’re more likely to cause stomach bleeding and ulcers when alcohol is consumed. Drinking while taking acetaminophen (Tylenol) leaves you more vulnerable to liver trouble, too. Another problem with drinking alcohol while taking medication for RA is 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 as adalimumab (Humira) or etanercept (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 the National 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 includes tofacitinib (Xeljanz), baricitinib (Olumiant), and upadacitinib (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 developing osteoporosis or already dealing with bone 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 the National Institutes of Health Osteoporosis and Related Bone Diseases National Resource Center. Additional reporting by Susan L. Sullivan and Erica Patino
