Doctor... I Have Rheumatoid Arthritis - Can I Drink Alcohol?
By Nathan Wei

Rheumatoid arthritis (RA) is the most common chronic disease and the most common cause of crippling. RA affects roughly 2 million Americans.

The treatment of RA involves the use of two major types of medications. The first type is the anti-inflammatory group. These help with symptoms. The second type is the disease modifying group. These help slow the disease process down.

Both groups of medicines are metabolized through the liver. What that means is that it is not a good idea to use alcohol either heavily or chronically while on these medicines. In fact, many rheumatologists advise their RA patients taking methotrexate- one very common disease modifying drug- to avoid alcohol altogether.

Another issue is the increased rate of peptic ulcers that can develop in patients taking non-steroidal-anti-inflammatory drugs (NSAIDS). Concomitant alcohol use increases the risk of ulcers.
Now… what is the evidence to the contrary?

A recent Swedish study found that a copious dose of alcohol reduced the risk that mice would develop rheumatoid arthritis.

Lead researcher Dr. Andrzej Tarkowski, professor of rheumatology at Goteborg University said, "I wouldn't dare to do it (the experiment) in humans."

The mice were given a daily regimen of tap water supplemented with 10 percent alcohol. "That would do liver damage in humans," Tarkowski noted.

Tarkowski, published the findings in the Proceedings of the National Academy of Sciences (December 19, 2006).

Tarkowski was interested in the mechanism by which alcohol might help prevent rheumatoid arthritis, an autoimmune condition in which the body attacks its own joint tissue.

"We have shown that it goes through the up-regulation [increase] of testosterone," he said. "That down-regulates inflammation, which is part of the arthritic process."

"Test tube studies also show that alcohol increases the migration of white blood cells, which take part in the inflammatory process," Tarkowski added.

In the experiment, male mice were given injections of collagen to induce rheumatoid arthritis. The researchers noted a significantly lower onset of disease and fewer destructive symptoms in mice who drank water with 10 percent alcohol added in, than in those who drank plain tap water.

Does this now give permission for RA patients to party hardy?

The study has very little application to humans in that it was a study designed to study possible RA prevention in male mice through testosterone modulation.

Since most RA patients are women, the results of the study probably aren’t useful for most RA suffereras. It might be interesting someday to look at possible RA prevention in men using alcohol but it’s entirely too premature to look at it now.

Tarkowski also alluded to the possibility of using acetaldehyde, a breakdown product of alcohol, in preventing rheumatoid arthritis. Acetaldehyde though is toxic and it would have to be used cautiously, if ever, in a human trial.

My advice is that it’s OK to have an occasional drink. In particular, there is evidence that red wine might have beneficial effects as far as cardiovascular risk, which is a real worry in RA patients who appear to have accelerated atherosclerosis as part of their disease. But do it in moderation.

Nathan Wei, MD, FACP, FACR is a rheumatologist and Director of the Arthritis and Osteoporosis Center of Maryland (http://www.aocm.org). He is a Clinical Assistant Professor of Medicine at the University of Maryland School of Medicine and consultant to the National Institutes of Health. For more info: Arthritis Treatment

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