Methotrexate and Rheumatoid Arthritis: Is Alcohol Consumption Safe?
RA Medicines were a gift
The day I finally met the good rheumatologist, I was given several prescriptions. But, they weren’t Christmas presents. They came with stern warnings. Do not get pregnant; do not drink any alcohol… the regular drill.
At that point, I was scared stiff. Well, I was stiff already anyway. However, I was also scared. I was not scared of the medicine; I had learned enough about rheumatoid disease that I was more scared of the disease than anything else.
RA had disabled me almost instantly and I lived with more pain every day than many people will ever know. RA had taken my grandfather also. I knew I wanted the best medicine I could find. Whatever the RA specialist told me to do, I did. There was no complaining, no arguing, and definitely no drinking.
Methotrexate & Rheumatoid Arthritis & alcohol warnings
Although my rheum doctor stipulated that I not drink at all, many RA specialists in the US follow this rule of thumb which you will find stated in many places: consume no more than 2 alcoholic drinks per month. In Europe, it is more liberal. People with rheumatoid disease (PRD) are often given the limit of 2 drinks per week.
I’ve been wondering what the truth is. Does anyone know whether it is safe to consume any alcohol while being treated with methotrexate for RA? What is the risk to the liver? Do they study these things?
Studying methotrexate, RA, and alcohol
There are not a lot of scientific trials studying alcohol, RA and methotrexate. However, in 2006, a study of 550 PRD demonstrated “Alcohol consumption did not correlate with hepatic (liver) injury…” The average consumption of alcohol for Rheumatoid Arthritis patients in the study was 5 units per week. (I suppose that units are standard-sized drinks.) The researchers also found that methotrexate-treated Psoriatic Arthritis patients were at greater risk for liver toxicity than Rheumatoid Arthritis patients treated with methotrexate are.
Hidden among the other blockbusters from the American College of Rheumatology (ACR) scientific meeting last October were two reports regarding alcohol and methotrexate. Rheumatoid Arthritis patients use methotrexate more than any other drug. And many of them consume alcohol. So, I’m glad someone is looking at this.
One study of almost 900 PRD demonstrated an inverse relationship with alcohol consumption to both incidence and severity of RA. This confirms something which has been shown previously: “Alcohol associates with a lower risk for rheumatoid arthritis.” There is no implication of causality. The researchers did conclude that further study is needed.
A second study presented at ACR examined methotrexate-taking RA patients classified as alcohol “drinkers” and alcohol “abstainers.”They found “no difference in the percentage of drinkers (34%) and abstainers (34%) having at least one abnormal LFT (liver function test) result.” The “drinkers” tended to report less pain. It was concluded that further study is necessary, acknowledging that many PRD taking methotrexate do continue to drink.
Can PRD on methotrexate drink moderate amounts of alcohol safely?
Like so many other decisions people have to make, risks and benefits must be weighed. There are often medicines in addition to methotrexate to consider, which can react with alcohol or have a compounding effect. There are also past history of alcohol use and health of liver to consider.
Postblog: I read several articles preparing for this post. This made me laugh out loud: a young columnist on a how-to Q&A site wrote, “Never” consume alcohol if you take methotrexate. Over in the corner I noticed a list of her other articles. One was called How to Dye Part of Your Hair Blue. I decided I better find a more scientific site.
Note: other articles relating to alcohol will be tagged Alcohol and Rheumatoid Arthritis. Please check that tag.
Recommended reading:
- Methotrexate and Rheumatoid Arthritis index (7 pages & counting)
- How well do Biologic medications help Rheumatoid Arthritis?
- Can I Delay Treatment for Rheumatoid Arthritis? part 2
- Disclaimer for RA Warrior website
I see no new comments since my own in January. On Monday I will administer my first mtx injection. I wondered if there is any new information regarding this topic and also whether it is possible to see the other 33 comments (of the noted 83) that are not visible? Thanks so much!
If there are more than 50 comments, WordPress (the platform used on this site) puts them n another page. There’s always a link at the top and bottom of the page to “read older comments” – or newer. I hope that helps and good luck with your mtx. I’m on my phone right now so I can’t get u the link but if you click on the tags list of topics there are many other articles on mtx , some newer althoughI agreeit’s alwaysa topic we need to come back to.
Hi Terri: I also am 61 yrs old. Diagnosed with RA around last oct (2012) I inject methotrexate every Friday evening. And I do drink on Sat and Sun. Max 2 drinks on those 2 days. Rheumy (who is very very young)said absolutely no alcohol, so I did not drink at all until March 2013. I was too scared to have a drink. My family doctor whom I have been going to since I was 21 said it was perfectly ok to have 2 drinks on sat and sun. He also said I could have 2 drinks every day if i so choose and it is Not going to hurt me or damage my liver. I said what the Rheumy said and he said that since you have never and do not over drink, not to worry. There are 2 other people I work with and they also have a couple of drinks on the weekends. They say that we have already given up so much, so go for quality of life. I guess if I ever have a bad blood test (liver), then I will stop drinking my couple of drinks on the weekend. For now, I am going to enjoy my beer or vodka and grapefruit juice.
thanks for this thread and blog! I can’t believe I never looked for other people who might be dealing with the same/similar things. I have been living with RA for about 13 years, and at 25, finally feel like I have a doctor who is listening and helping, and teaching me. thanks for the blog and posts!
This is the best article I could find on the subject. It has a large sample size and suggests low-to-moderate alcohol consumption is not correlated with a statistically significant increase in liver damage.
I’m not sure if this has already been posted, so I thought I’d post it anyway 🙂
http://www.scirp.org/journal/PaperInformation.aspx?paperID=21764
Shouldn’t we attempt to weigh the risks of low alcohol consumption against the benefits? Low alcohol consumption has been correlated with reduced risk of heart disease. Couldn’t this suggest that low levels of alcohol consumption might be a reasonable way of balancing potential risk to our livers against potential benefits for our hearts?
Apologies for not confining my thoughts to one message.
There is another post here with discussion of a study showing statistical benefits for RA – less susceptible to Rheumatoid Arthritis or less likely to develop erosive RA.
https://www.rawarrior.com/rheumatoid-arthritis-news-articles-volume-1/
I’m glad to find this info and find that others do imbide. I was just diagnosed and I have to say, I was horrified when the first doctor told me I couldn’t drink. It’s part of my socializing. The first doctor said I’d be really sorry if I ever drank on methotrexate, that there was no way to tell if it was affecting my liver. My second doctor told me he doesn’t care if I drink every day, just don’t spike my blood sugar up … he clarified later by saying I should keep it to one, maybe two drinks a night, but with food, and it should be one drink per hour. I think I can live with that … my father has RA and still drinks beer. But the first doc scared the heck out of me. So I’m glad to find this info.
So happy to find this site. It’s really helpful- this is quite a scary and difficult time- not to mention painful.
I’ve still not been officially diagnosed- rhum. doc (and his colleague) are pretty convinced that thisis RA because I have classic symptoms but because none of the blood tests have turned up positive yet, they are calling it seronegitive inflammatory arthritis. It’s been about 5 weeks- came on suddenly with horrible pain in knees, swelling in hands and feet, continued consistently although 2 weeks on prednisone brought down the swelling somewhat (still cannot see my knuckles). Still in horrible pain – especially in the mornings which are torture. They re-ran all of the blood tests today and in spite of my objections, he prescribed methotrexate which I am terrified to start. Partly due to the potential side effects which sound dreadful and partly because of the limitations of alcohol since I drink red wine very often. The idea of giving this up is very upsetting- it also is part of my work in the hospitality industry. I’m also panicked about having to deal with this amount of pain for the rest of my life so I’m really in limbo here trying to figure out what makes the most sense.
Sounds like 2 glasses or a bit more per week is probably not going to kill me or my liver. Anyone else have any experience drinking more then 2 glasses a week?
Here’s another question. Do I now expect to be on metotrexate for the rest of my life of is this something one takes only during flare up periods?
Thanks all for continuing to share your stories.
Kelly, I am so excited to find this web site after being diagnosed 2 months ago. You are super woman! 5 kids and also publishing the most informative RA web site while also struggling with this awful disease. Where do you find the energy? This discussion is so interesting to me because it is the first forum where people have said they actually still drink on MTX. I seems on every other forum people say their docs tell them they can maybe have 1 drink per year. That would really depress me! My doc in Chicago seems very knowledgeable and more progressive. He said the RA docs used to think that way, but after years of doing useless liver biopsies and not finding much, they have changed their tune. I said I would like to have a few glasses of wine a few times a week, which he said was fine. He said there might be an issue if I had a few glasses of wine every day.
Karyn, if MTX works for you (with or without a biologic) you will most likely take it indefinitely. It takes a while for it to start working, and even if it doesn’t help the pain, it is probably helping to stop the disease progression. I have noticed about a 50% relief in my symptoms and just started Enbrel last week, so I feel like I am one of the lucky ones!
Good to meet you, MLR. 🙂 As for me, I am certainly not superwoman any more. I don’t do most of the mom things I did once. And my kids have gotten older, only four left at home and two are over 18. Still a busy house, but not the same as when they were little.
As for alcohol, it must just be easier for most to say “none” is the safe amount. But the reality is that it is based on a person’s whole profile with regard to their liver. Is it healthy? What other meds do they take? What is their medical history or family history? I’ve heard doctors like yours make similar statements. Mtx can harm the liver (or lungs), but it seems to be rare.
Kelly, I agree with what you say because I feel most doctors and patients prefer to be safe and say no drinking at all. I also asked a very highly regarded oncologist friend of mine (he is often on CNN) and he said MTX is a very safe drug. He also agreed with my doctor that a moderate amount of drinking should be fine if my blood work is okay.
I also have to compliment you on the organization of your web site. I love the drop down list of topics. Much better than any other site I have seen! Thanks for helping us all!
Hi,
No alcohol warnings on my mtx bottle! Just said avoid prolonged sunlight.
I must have drunk 3+ bottles of red wine to wash down 20mg mtx. That was nearly a week ago and I’m not dead.
After reading this post and comments I guess I better go have a blood test….
Anyone else done this?
Cheers,
C
Hey Kelly!
I’m a freshman in college and I got diagnosed with RA as a Junior in high school. As tough as it has been for me, I LOVED reading this post and it even made me feel more at ease. I’ve been taking methotrexate since I have been diagnosed and while consuming alcohol has always been a great concern for me (I mean I am a teenager, come on!) it’s never been a problem with my regular blood work to check if everything is working. I am so glad I found someone to say the same thing that I have been thinking. It’s great knowing I’m not the only person drinking on methotrexate. Just thought I would share!
XOXO
-Katlyn
Very honest and interesting article. Thank you!
Im 22 years old, can you please tell me one more time that I shouldnt be drinking? I know that, but I thought I was doing exceptionally well by limiting my drinks to only once(maybe twice) a week.
I do find my symptoms worsen the day after a little bit, but nothing a long rest wont make disappear.
I will keep drinking while on methotrexate and screen my liver regularly, Im not going to let RA ruin my social life, whats the point of that?
Thanks for this great article!
Oh, my goodness! The posts on this topic are really interesting and informative. I drink a beer or a glass of wine almost every evening with my husband. Sometimes, I drink two. On weekends, I don’t keep track. It doesn’t seem to cause flares and it does help me cope with the physical pain as well as the emotional pain of being unable to do things which once were simple. (I climbed a ladder the other day for the first time in a few months and felt like I had made it to base camp on Everest!) I was diagnosed in June but was pretty sure I have RA beginning in early April! Shortly after my 65th birthday! (Ugh! That sounds so old!)
I have been acutely aware of RA and the suffering it causes all my life. My mother was diagnosed while she was pregnant with me. It is impossible for me to imagine how hard it must have been for her. There were no treatments then as far as I know. She took heavy doses of aspirin and, sometimes, cortisone injections. She also enjoyed alcohol regularly. By the way, I grew up in a Bible belt state where the laws and the attitudes about alcohol are strongly ambivalent! I wonder how often restrictions on alcohol consumption are a result of such ambivalence.
I started methotrexate three months ago and when I saw the rheumatologist for the second time he added Humira to my treatment plan. I am also taking prednisone but the plan is to eliminate it when the Humira has had time to work.
Coming to grips with having RA after thinking I had dodged the bullet for 35 years would have been much more difficult without a little alcohol-induced relaxation!
Cheers!
I was diagnosed with RA just a couple of months back — am on 6 x 2.5 mtx; but I am one of the lucky ones as my symptoms are comparatively mild and any nasty flare-ups, very short. Since my twenties, I have been a big social drinker, so to discover a “do not drink alcohol with this medication”-sticker on my first prescription of mtx was a nasty jolt! However, when I raised the alcohol question with my rheumy on my second visit, he asked no questions about my drinking history but told me I could safely drink 2-3 units of alcohol per week. (I live in US). I was really happy to hear this, as I greatly enjoy the flavor of a good beer, and would find it a huge loss if I could not have one occasionally. As someone who used to drink quite a lot when out and about with friends, though (oops!)I have found alcohol-free beers an acceptably palatable way of keeping up with the crowd — most pubs now serve alcohol-free beers; and I now take along a bottle of alcohol-free wine for a night in with “the girls”. There are so many different types of alcohol-free wine out there to sample. (My favourite is a “Brut”-type sparkling wine: I pour it in a pretty champagne flute, add a splash of cranberry juice, and — hey, presto! — a lovely champagne cocktail I can safely drink all night!) I am now experimenting with making alcohol-free cocktails. (A brother got me a book on these for Christmas — a very thoughtful present!) Served in a pretty glass with a piece of fruit on the side, I am sure these cocktails-minus-the-alcohol will still make a fun and enjoyable drink. So to anyone out there who(before Mtx)was a big social drinker, I would just say that the world of non-alcoholic but look-alike beers/wine/cocktails is (in my experience) one well worth exploring. I don’t feel like the odd one out at social gatherings when I can enjoy some of these.
Sorry — forgot to state that I am now 58 years old; so I’ve been a big social drinker for over three decades now!
Interesting article, thanks. I’ve been taking methotrexate for RA since 1997 but am teetotal anyway. However I work for a drug and alcohol advice line. Your article states you assume units are standard size drinks but this is not so. A unit of alcohol can be easily calculated by using the ABV% of the drink and the quantity you have; eg a litre of 12%abv wine is 12 units. So if you have one 250ml glass you are having 3 units. I hope this makes sense but please ask for more details if you want!
Pingback: I miss beer :(
This has been a great read! I’ve battled RA for quite a few years now, I’m 26 this year so it’ll be 22 years I’ve had it – in every joint. I’ve been on this drug now for 3 months after swearing I’d never go back on it (I had awful side effects when I took it as a kid) but it was a last ditch effort. It was very, very hard coming to grips with the fact I might not be able to enjoy a beer or two (if any) while on this drug as I work in the craft beer industry as well as being an avid home-brewer….Almost to the point where I’d rather deal with the pain but the side effects of 20mg a week haven’t been too bad aside from awful fatigue the day and day after taking it. I’ve cut down quite a lot but still enjoy a few beers on the weekend.
If anything, this has been a well needed lifestyle change as I was drinking quite excessively due to depression cased by Embrel.
I’d still prefer to be off this drug If I can – but that’s just personal preference.
I have only been taking MTX and Prednisone for a month and I too was more concerned with a dry social life than my new enemy RA. Stangely enough I have several neighbors living on the same street as me in a golf communitee that see the No connection I am sure. One very nice man who is on the same dose as me, has a drink every night except the night before and after, with no adverse affects.
I am doing the same. Take the dose Monday night, sleep and not drink until Wed. No drink Sunday. Have not had any problem except I am having hair loss. Also now see very curly hair growth at the hair line.
My Rheumy said the NO Alchohol rule is only in the USA. I think a little experimenting is ok. If you suffer, don’t do it.
I was dragging the chain and scared to start methotrexate, my rheumatologist said it was my best option to get in early and stop the inflammation. I said ‘ how long will I have to be on it?’ She said ‘ years’ I said ‘ that is such a long time between drinks’ she laughed and said “I am very relaxed about you having a glass of wine” I said lets do it then. All of a sudden I felt like I could cope. Don’t judge me it’s the little things in life that make up the whole.
I have had a raised liver enzyme result and had to come off methotrexate for a week until it settled down, it was the week that I didn’t have any alcohol! So I have a glass of wine at the end of the week, feel far too sick to consider it after pill days. Hope this helps. I live in Dunedin, New Zealand there is a medical school attached to the hospital.
I have been taking Methotrexate for 8 years for the treatment of RA. I am a 64 year old female and live in France. My rheumatologist (French) never warned me about drinking alcohol. He speaks SOME English and I have asked him about it and he seems to appear not to know whether drinking whilst taking this drug is OK. I do abstain for at least 2 days per week and sometimes more. I only drink wine if it is watered down making it about 2 thirds wine to one third water. I drink a small amount varying between 3 to 5 days per week but I am becoming increasingly worried about how dangerous this may be as I have read that the rule is NO ALCOHOL at all. Help!
Maybe the advice was changed since this thread started – I just got diagnosed a few months ago. My rheumatologist said I could have one drink a *day* or up to two drinks 3 times a week – as long as I didn’t drink more than two drinks a day or seven a week. I’m on pretty much the lowest dose of MTX (10 mg/week) so maybe that influenced it. With the MTX I can feel my tolerance has gone way down though – I don’t usually want to drink.
This has been one great thread. I have been on methotrexate for a year (10 mg) and follow similar rules to others. Take meds on Monday, abstain following 72 hours and average 2 to 3 glasses of wine three days a week (yes sometimes 9 glasses). Have been fine and no adverse reaction. Liver tests well within normal range.
I am glad I found this thread also, and in reading these posts, I have allow myself to indulge with a few glasses of wine on the weekend. So far no issues. Always curious, I have been doing further research on this subject and see that maybe things are changing. Looks like moderate drinking on MTX is fine. This was published in a rheumatology publication in 2016.
http://www.mdedge.com/rheumatologynews/article/108733/rheumatoid-arthritis/study-backs-moderate-alcohol-intake-mtx
New advice from the NRAS states that up to 15 units of alcohol and week is safe