You may be inclined to toast family and friends this holiday season. But if you have rheumatoid arthritis, think twice about what goes into your glass. “In and of itself there’s no problem with moderate amounts of alcohol if you have rheumatoid arthritis. The problem comes when you’re taking certain medications,” says Dr. Sean Whelton, a rheumatologist with Medstar Georgetown University Hospital.
Understanding RA
RA is an incurable autoimmune disease. It occurs when the body’s immune system mistakenly attacks the lining of the joints, called the synovium. The attack causes the synovium to release chemicals that irritate nerves, cause pain and damage the synovium, ligaments, cartilage and bones.
RA attacks flare up periodically. When they do, people with RA can experience swollen joints that are warm to the touch, joint tenderness and joint stiffness. The hands, feet and wrists are typically affected, but any joint and even some organs can suffer. RA attacks may also cause fatigue and low-grade fever.
[Read: Holiday Gift Ideas for People With Arthritis.]
Prescription Medications and Alcohol
Treating RA typically involves prescription medications. The most common is called methotrexate (Rheumatrex, Folex). It’s a disease-modifying antirheumatic drug, or DMARD, that helps reduce RA inflammation and progression, according to the Arthritis Foundation.
Doctors advise that you avoid alcohol entirely if you’re taking methotrexate, which is broken down in the liver. “Methotrexate can increase the risk of liver toxicity, and chronic alcohol use can increase the risk of liver toxicity and potentially cirrhosis. So the combination of both alcohol and methotrexate is particularly bad,” explains Dr. William Martin, a rheumatologist with Ronald Reagan UCLA Medical Center.
Another DMARD called leflunomide (Arava) may also be risky if you drink alcohol while taking the drug. “On average, it’s known to have slightly more risk of liver toxicity than other medications,” Martin says.
What about drinking alcohol if you take other DMARDs or biologic RA medications, such as adalimumab (Humira) or etanercept (Enbrel), which inhibit the immune system? “They can be used safely in people who consume moderate amounts of alcohol,” Whelton says.
Moderate alcohol consumption, according to the Dietary Guidelines for Americans, means no more than one drink per day for women and no more than one or two drinks per day for men. One drink is the equivalent of 1 ounce of liquor, 5 ounces of wine or 12 ounces of beer.
[Read: How to Prevent the Onset of Rheumatoid Arthritis.]
Over-the-Counter Drugs
Even moderate alcohol consumption is not advised for people who take over-the-counter nonsteroidal anti-inflammatory drugs, or NSAIDs, to treat the pain and swelling of RA. Examples of these medications include ibuprofen (Advil) and naproxen (Aleve).
Long-term use of these drugs is associated with health risks such as stomach inflammation, stomach bleeding, ulcers, kidney problems, high blood pressure and heart attack or stroke. Those risks increase if you add alcohol into the mix, so it’s not recommended. Long-term use is typically a few months, but some risks (such as heart attack) can increase after as little as a few weeks, according to the FDA.
However, Martin says it’s probably OK to have a drink of alcohol once a year if you take NSAIDs. “Having one drink around the holidays while taking anti-inflammatories should be OK unless you have preexisting heartburn or known inflammation in the stomach lining,” he says.
Other Considerations
Drinking alcohol can contribute to other complications of RA. For example:
— Sleep disturbance. People with RA often have trouble sleeping. Drinking even small amounts of alcohol can also lead to fragmented sleep, making an RA patient’s sleep troubles even more challenging.
— Depression. RA and depression often occur at the same time. Although it doesn’t feel like it initially, drinking alcohol can worsen depression symptoms.
— Osteoporosis. RA increases the risk for developing osteoporosis, the condition characterized by brittle bones that break easily. Excessive alcohol consumption is also linked to osteoporosis. So is it wise to have an occasional drink if you have RA? “Occasional alcohol around the holidays is probably not horrible for your bones. But avoiding alcohol is better than drinking it, from an osteoporosis point of view,” Martin says. “Alcohol consumption can also increase the risk of falls, and that increases the risk for fractures,” Whelton points out.
— Heart disease. Excessive alcohol consumption is linked to heart disease. But people with RA already have higher risks for heart attack and stroke.
[Read: You’ve Just Been Diagnosed With Rheumatoid Arthritis. What Do You Need to Know?]
What About Alcohol’s Protective Effects?
You may hear about the potential protective benefits of alcohol. “There’s some evidence that a small amount of alcohol intake can decrease systemic inflammation,” Martin says. Decreased inflammation is thought to be a possible explanation for the link between moderate alcohol consumption and a lower risk of developing heart disease.
And a 2014 study suggested that women who drank two to four beers per week had a 31 percent decreased risk of developing RA, compared to women who never drank beer.
But Whelton isn’t convinced that there’s enough evidence yet that to say that alcohol consumption offers protection against RA. “Decreasing inflammation to help with cardiovascular health is different than treating an immune system that’s attacking joints,” he says. “It’s a different type of inflammation and a different intensity of inflammation.”
What You Should Do
Talk to your doctor before drinking alcohol if you have RA. The types of medications you take may dictate whether moderate alcohol consumption is safe.
Even if it is safe medication-wise, there are many other risks you’ll need to talk about with your doctor before you can raise a glass of holiday cheer without worrying about the consequences. “My patients don’t spontaneously combust if they have a drink at the holidays,” Whelton says, “but beware.”
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Can You Drink Alcohol If You Have Rheumatoid Arthritis? originally appeared on usnews.com
