Should patients with rheumatoid arthritis drink alcohol? What are the dangers of mixing alcohol and rheumatoid arthritis medications? Find out these answers and more.
Although some research has shown that drinking the equivalent of one glass of an alcoholic beverage a day could lower your risk of developing rheumatoid arthritis, once you have RA, drinking alcohol may be quite dangerous.
Methotrexate (Rheumatrex, Trexall) is in the class of drugs known as disease modifying anti-rheumatic drugs (DMARDs), and is typically the first DMARD considered in treating rheumatoid arthritis patients.
Although methotrexate is effective in reducing the signs and symptoms of rheumatoid arthritis and may slow or even halt damage to the joints, it has been associated with liver damage. Leflunomide (Arava), another DMARD, may also increase the risk of liver toxicity in RA patients.
“At least one in 1,000 patients taking methotrexate will develop liver cirrhosis,” says Robert W. Lightfoot, MD, a professor of internal medicine in the division of rheumatology at the University of Kentucky in Lexington. “It is not known whether methotrexate alone causes the cirrhosis or if drinking alcohol while taking methotrexate is the cause.” However, such liver damage experienced by rheumatoid arthritis patients usually occurs in those who have pre-existing liver disease or alcohol abuse. Dr. Lightfoot adds: “The risk [of developing liver cirrhosis] is so low, and the benefits of taking methotrexate are so high” that methotrexate continues to be the drug of choice for rheumatoid arthritis treatment.
Methotrexate and leflunomide are not recommended for rheumatoid arthritis patients who have liver disease or who are suspected of abusing alcohol. Because of the potential for causing liver damage, patients taking these medications should limit their alcohol consumption to no more than two drinks per week. Some experts recommend that RA patients who are taking methotrexate refrain from drinking any amounts of alcohol.
Another problem with drinking alcohol while taking medication for rheumatoid arthritis is that alcohol can make it difficult for your physician to assess your tolerance of the particular drug if you have increased liver enzymes. Your doctor may not be able to determine if it is the RA drug or the alcohol that is causing your increased liver enzymes. Even if you do not drink alcohol, to prevent potential damage to the liver, your doctor may have you stop your RA medication if your liver enzyme numbers increase.
Drinking alcohol can reduce bone density and a lower bone density puts you at greater risk for complications from arthritis, including fractures. Drinking in moderation might not be a problem, but you should ask your doctor how much is too much.
Non-steroidal anti-inflammatory drugs (NSAIDs) may also be prescribed for rheumatoid arthritis patients to treat acute inflammation of the joints and to relieve pain. NSAIDs include aspirin, ibuprofen (Advil, Motrin), and naproxen sodium (Aleve). These medications may cause irritation of the lining of the stomach, which can lead to ulcers and bleeding in the gastrointestinal (GI) tract.
Alcohol also has the potential to irritate the lining of the stomach. Rheumatoid arthritis patients who consume alcohol at the same time they take an NSAID may increase their risk for ulcers and GI bleeding. Prednisone, a steroid used to treat rheumatoid symptoms, also has the potential to cause GI bleeding. Additionally, rheumatoid arthritis patients who drink alcohol and take large doses of acetaminophen have an increased risk for liver toxicity.
“If a patient is not taking methotrexate or experiencing liver problems, there is no reason not to drink alcohol in reasonable quantities,” says Lightfoot. But you may want to avoid alcohol in any amounts if you have any stomach irritation or if your liver enzymes increase.
Forgoing the alcohol will allow you to continue taking your rheumatoid arthritis medication without risking damage to your liver or GI tract.
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