There is a lot of information out there about rheumatoid arthritis (RA) and drinking alcohol — and much of it seems contradictory. For example, past research has found that drinking alcohol was associated with lower RA disease activity. But another study seemed to show that alcohol could cause higher levels of key inflammatory markers in people who later developed RA. So, is alcohol harmful if you have RA? In short, it depends.

Given all the information out there, deciding how and when (or if) to drink alcohol when living with RA can be a challenge. When you factor in the ways that alcohol can interact with the various medications used to treat rheumatoid arthritis, this decision can become even more complicated.

If you or someone you love is trying to decide whether or not to drink after a diagnosis of rheumatoid arthritis, here’s what you need to know.

How Does Alcohol Consumption Affect Rheumatoid Arthritis?

Although alcohol intake appears to correlate with a lower incidence of RA and less severe RA symptoms in some studies, it’s important not to jump to conclusions about cause and effect.

Researchers suggest people with less severe symptoms may tend to drink more because they’re healthier and feel good, whereas those who are experiencing more active RA disease progression stop drinking or don’t start. In other words, when people diagnosed with rheumatoid arthritis don’t feel well, they don’t drink nearly as much.

These drinking trends as they relate to disease severity can make it appear that moderate alcohol consumption has positive effects on the disease. But in reality, the amount of alcohol a person consumes may not be responsible for the severity of a person’s symptoms.

Alcohol may not have a considerable effect on rheumatoid arthritis at all, experts say. If it does, the effect of alcohol may vary from person to person. Thus, it’s important to note how you feel after you drink. If your joints feel more swollen and sore than usual, you may want to avoid alcohol in the future.

As one myRAteam member wrote, “I would say alcohol affects my joints.” Another agreed: “I woke up this morning, and my hands were so swollen and painful. I think it’s because I had alcohol last night.”

However, other members find that alcohol seems to help them. As one member explained, “I’ve been so sore in my hands, wrists, and knees. Alcohol helps.”

Ultimately, one of the best things you can do is to pay attention to your body. Take note of whether your symptoms change after drinking — and, if they do, how they change. If they become more severe or persistent, you may want to reduce or eliminate alcohol.

Alcohol and Rheumatoid Arthritis Medications

Even if you feel fine after drinking or if your rheumatologist doesn’t give specific recommendations when it comes to alcohol, your RA medications may determine whether alcoholic beverages are safe for you. That’s because alcohol may interact with certain RA medications to cause risky side effects.

Alcohol and Nonsteroidal Anti-Inflammatory Drugs

If you take nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil), naproxen (Aleve), or celecoxib (Celebrex) to help with your RA symptoms, be careful about drinking alcohol. Even in people without RA, NSAIDs can cause bleeding in the gastrointestinal tract, especially when used over an extended length of time. This bleeding can be severe and can be a major health complication.

The more alcohol you drink, the higher your risk of bleeding in the gastrointestinal tract if you are taking NSAIDs. If you would like to drink alcohol while taking NSAIDs, seek medical advice from your doctor. Ask how much you can drink based on the particular NSAID you’re taking, your dose, and how long you’ve been taking it or plan to.

Alcohol and Disease-Modifying Antirheumatic Drugs

Some people with rheumatoid arthritis take disease-modifying antirheumatic drugs (DMARDs) or biologics (a subset of DMARDs). Methotrexate is a conventional DMARD used to find symptom relief. For years, people have been advised to avoid drinking alcohol almost entirely while taking either of these classes of medications.

The main concern with drinking while on these medications is liver damage. These medications are already hard on the liver, as is alcohol. When you combine the two, you can accelerate the risk of liver damage. The combination can lead to elevated liver enzyme numbers, fibrosis, and even permanent liver damage.

Members of myRAteam have been cautioned by their doctors, too. One member wrote, “My new rheumatologist does not want me to have ANY alcoholic beverages while on methotrexate.” Another shared, “Every time I go to the rheumatologist, he reminds me, ‘No alcohol!’ He said that most RA meds can harm the liver over time and, if one drinks alcohol, you can double your chances of liver problems.”

Many people find it hard to cut out alcohol entirely, however. As one member lamented, “The worst part about taking methotrexate is NO alcohol! I’m German, and I miss my beer! I think I’d rather have the joint pain!”

If you want to drink, there are some RA medications that may be better candidates for you, such as hydroxychloroquine (Plaquenil) and sulfasalazine (Azulfidine). Talk to your doctor to find the right rheumatoid arthritis medication for your situation. Be honest with your rheumatology provider about your alcohol use. They may want to tailor your medication regimen to account for your alcohol use.

Drinking Safely With Rheumatoid Arthritis

If you don’t drink now, it’s wise not to start. Alcohol presents many different health risks that may outweigh any potential benefits. If you have RA and choose to drink alcohol, take steps to reduce your risk of complications.

Be Honest With Your Health Care Team

Your rheumatologist’s job is to keep you as healthy as possible — not to be judgmental about your drinking choices — so be honest with them. Your doctors need to know the types and amounts of alcohol you drink so they can determine what dosages of medication will minimize potential health risks.

Take Regular Liver Function Tests

It’s recommended that you undergo regular liver enzyme checks if you take a medication metabolized by the liver, such as methotrexate — especially if you drink alcohol. Being mindful of your blood work can help your doctor spot potential liver issues early on. If your doctor notices any changes, they’ll likely ask about your alcohol consumption and may advise that you cut back or stop drinking.

As one myRAteam member advised, “Apparently, alcohol use is a big problem that is getting worse. Be careful … with all of our meds, I don’t think it is wise to add alcohol to the mix.”

Listen to Your Body

Blood work can’t reveal all of the problematic effects of NSAIDs and alcohol on the digestive system if they start to occur. Let your doctor know if you experience any heartburn or stomach pain, which may indicate irritation in the lining of the digestive tract.

Drink in Moderation

It’s easy to underestimate how much you’re drinking. Remember that it’s healthier to limit yourself to one drink a day, if any — that’s 12 ounces of beer, 5 ounces of wine, or 1.5 ounces of liquor.

Many myRAteam members take care to monitor their alcohol consumption, like one who wrote, “I do drink. My rheumatologist said just to keep the amount low, so I watch my intake.” As another myRAteam member shared, “I have a beer whenever I feel like it. Sometimes, it just relaxes me to sit on the deck and sip a cold one.”

Get Support Today

Being diagnosed with rheumatoid arthritis can pose many new, confusing questions. Although your health care team can help answer many of them, you may want insights from others who are living with RA.

On myRAteam, more than 200,000 people understand the challenges of life with rheumatoid arthritis. Members ask and answer questions, offer support, and share stories of daily life with RA. If you are feeling alone or have questions that need answers, reach out today.

How has choosing to drink — or not drink — affected your RA? Share your experiences in the comments below or by posting on myRAteam.