Have yourself a ‘merry’ little Christmas? The facts on RA and alcohol

Blog by Victoria Butler

The UK has a long history with alcohol. In the middle ages, many men started their day drinking a beer with breakfast! Apparently this is not due to water being unsafe to drink (this appears to be a widespread myth) but rather that the calorific content of the beer gave them an energy boost and, at less than 2.8% strength, this wasn’t counteracted by the alcoholic content. 

In more recent years however, we have become more aware of the impact both socially and to our health, particularly around the dangers of ‘binge drinking’. The stats on this make for some sober reading (pun intended). In 2020, there were an estimated 525,000 incidents of violent crime where the victim believed the offender was under the influence of alcohol and the proportion of violent crime linked to alcohol was 42%. In 2020/21, there were an estimated 247,972 alcohol-related hospital admissions where the main reason for admission was due to alcohol. 

The stigma around binge drinking can sometimes make it difficult for people to feel comfortable asking their healthcare team about alcohol consumption. You may worry that if you ask if it is okay to drink while on your medication you will be told that drinking nothing is always safest, or be labelled an alcoholic for even feeling the need to ask about it! 

Our message this Christmas? Don’t feel ashamed to ask about it. Many choose not to drink or abstain from alcohol for religious or other reasons. Some (around 7% of the population in the UK) have dependency issues with alcohol. A large proportion of the population choose to drink alcohol and do not have dependency issues. Whichever group you fall under, it is important that you feel comfortable discussing this with your healthcare team. 

For many, social drinking is important, whether meeting up with friends at a local pub, restaurant or houses, and this is can be especially true at Christmas time, when many of us over-indulge on both drink and food. The news on what this means for your RA might not be as bleak as you imagine. 

The issue with alcohol and rheumatoid arthritis is largely dependent on the medicines you are taking and the amount of alcohol you consume. A drug like methotrexate (the most commonly prescribed medicine for rheumatoid arthritis) is broken down in the liver, as is alcohol. Each time your liver filters alcohol, some of the liver cells die. The liver has the ability to repair itself, by creating new cells, but if you drink large amounts of alcohol over a long period of time, permanent damage can be made to the liver. A typical dose of methotrexate for people with RA would be below 25mg, and at this level, the NHS say that drinking alcohol is usually okay. Moderate drinking obviously puts less strain on the liver than binge drinking. Your liver function will be monitored through blood tests while taking methotrexate, so it is especially important that you be honest about your alcohol consumption, so that it is easier for your healthcare team to assess whether any high liver function test readings are down to medication or alcohol. 

Anti-inflammatory drugs (NSAIDs, such as ibuprofen and diclofenac) can also be affected by alcohol intake. NSAIDs can affect the lining of the stomach, and alcohol can worsen this side effect. The NHS state that moderate alcohol consumption whilst taking NSAIDs will not usually cause any harm. 

So, can your Christmas safely be ‘merry’ when you have RA? Though binge drinking could put too much strain on your liver, it may surprise you to learn that a number of studies suggest that those who drink a moderate amount of alcohol have improved RA symptoms overall when compared with non-drinkers.

For more information on RA and alcohol, read the article below.