Moderate alcohol intake OK for RA patients on methotrexate

2017 study shows that while the risk of liver damage in patients with RA taking methotrexate increases with higher levels of alcohol consumption, the risk in those consuming 14 units or less per week is no greater than those who do not drink.



Risk of liver damage for people who are on methotrexate is a concern that may increase when the decision about whether alcohol can be consumed is discussed. The American College of Rheumatology 1994 treatment guidelines stated that patients on methotrexate should not drink any alcohol. Then in 2008, the British Society for Rheumatology recommended limiting the amount of alcohol drunk by patients on methotrexate. However, there is still some confusion about the amount of alcohol that can safely be drunk, and some people feel nervous about drinking at all. But for some, it can be hard to abstain from drinking completely.

Researchers at the University of Manchester undertook a study to see if there is a safe amount of alcohol to consume whilst on methotrexate and if there is, how much is safe?

“In this study, we have demonstrated that the risk of transaminitis (liver damage) in patients with RA taking methotrexate does increase with increasing levels of alcohol consumption. However, the risk in those patients who consume 14 units or less of alcohol per week is no greater than those who do not drink alcohol” wrote William G Dixon, PhD and colleagues.

This study, the first large scale one looking at the risks associated with different levels of alcohol, was a retrospective one based on data collected in the UK.

The authors of the report suggest then that patients on methotrexate may be able to drink up to 14 units of alcohol a week, but over this limit, there is a higher risk of liver damage in a dose-dependent fashion. However, caution must be used by doctors in talking to patients about alcohol on high doses of methotrexate as the size of dose of methotrexate was not included in this study.

“Inclusion of acceptable alcohol levels into clinical guidelines and patient information may well improve informed decision making, clinical outcomes, reduce conflict and improve overall quality of life,” conclude the authors.

It is always best to discuss alcohol intake with your rheumatology consultant on an individual basis.

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