Is It Safe to Drink Alcohol If You Have RA?

Some environment and lifestyle factors can make rheumatoid arthritis (RA) symptoms and progression worse. One of the most well known is smoking. The relationship between RA and alcohol, however, is complex and not fully understood.^1,2

Experts know that alcohol can have a negative impact on your overall health. But some studies have shown it can actually help improve RA symptoms.³

The risks of drinking too much alcohol

When you drink alcohol, your liver processes and breaks down the ethanol. Heavy drinking can overload your liver with alcohol and lead to liver damage. Heavy drinking is defined as having 8 or more drinks per week for women and 15 or more drinks per week for men.^4,5

Other long-term risks of heavy drinking include high blood pressure, heart disease, stroke, and liver disease. Drinking too much alcohol also can weaken your immune system, increasing your chances of getting ill.⁴

Alcohol and RA medications

Alcohol can interact with some RA medications negatively. RA medications such as methotrexate and leflunomide are broken down in the liver. When someone with RA drinks alcohol, their liver needs to work harder to process both the alcohol and the medication. This can put a strain on their liver, which can cause damage and stop it from working properly.⁵

Another drug used to treat RA, non-steroidal anti-inflammatory drugs (NSAIDs), can also interact with alcohol. NSAIDs can affect the lining of your stomach, and too much alcohol can worsen this side effect.⁵

Research on alcohol and RA

There have been mixed results from studies looking at alcohol consumption and RA.¹

Alcohol and developing RA

Experts think that, along with genetics, environment, diet, and lifestyle factors are linked to the development of RA. These factors include smoking, low vitamin D intake, and high sugar and salt intake.^1,6

Several studies have found that drinking alcohol decreases the risk of developing RA. In the studies, as alcohol intake increased, the risk of developing RA decreased. This is called an inverse relationship. Some studies report that this is mostly the case in ACPA-positive RA.⁷

However, not all studies agree. One study in China found that drinking alcohol increased women's chances of developing RA. Alcohol did not seem to increase the risk for men.⁶

Alcohol and RA symptoms

Some studies suggest that a moderate amount of alcohol can ease RA symptoms. Studies in Europe found that moderate alcohol use lowered disease activity and improved quality of life.^3,7

However, one 2020 study found that gender was the more important factor than alcohol consumption in rates of RA remission. Men drank much more than women yet had milder symptoms. But when the results were adjusted for gender, alcohol did not seem to have an effect on RA symptoms.⁸

Drinking alcohol with RA

If you drink, alcohol should be taken moderately and as part of a healthy diet. If you have RA and want to drink, talk to your doctor. They will help you weigh the risks of liver damage and mixing alcohol with medications.⁹