Should Patients Who Take Methotrexate for Rheumatoid Arthritis Avoid Alcohol?

Summary and Comment |
September 14, 2017

Should Patients Who Take Methotrexate for Rheumatoid Arthritis Avoid Alcohol?

  1. Jonathan S. Coblyn, MD

Moderate intake might be safe.

  1. Jonathan S. Coblyn, MD

Patients who take methotrexate traditionally have been told to avoid alcohol because it might heighten risk for hepatotoxicity (i.e., beyond that associated with methotrexate itself). However, evidence to support this advice for patients with rheumatoid arthritis (RA) is limited. Researchers examined data on 11,839 RA patients in primary care practices in the U.K. who started methotrexate between 1987 and 2016. Alcohol intake was measured in “units,” defined as 8 g of alcohol per unit (in the U.S., a “standard drink” contains 14 g of alcohol, or nearly 2 units). Hepatotoxicity was defined as tranaminitis (i.e., elevation in alanine aminotransferase or aspartate aminotransferase ≥3 times the upper limit of normal [ULN]).

During 47,090 person-years of follow-up, 530 episodes of transaminitis occurred (crude event rate, 11.26 per 1000 person-years). Each additional unit of alcohol consumed was associated with an increase in transaminitis risk. Compared with no alcohol intake, an intake of 15 to 21 units weekly showed a trend toward higher risk; intake exceeding 21 units weekly was associated with significantly higher risk. Consuming 14 units or less weekly was not associated with excess risk for transaminitis. When transaminitis was defined as three consecutive transaminase levels above the ULN, no significant age- and gender-adjusted relation existed between any level of alcohol intake and transaminitis.

Comment

In this study, risk for abnormal liver blood tests in RA patients treated with methotrexate was very low in those with weekly alcohol intakes of 14 units or less. These results seem to support the idea that moderate alcohol intake is relatively safe in these patients, if liver blood test monitoring is performed.

Editor Disclosures at Time of Publication

  • Disclosures for Jonathan S. Coblyn, MD at time of publication Consultant / Advisory board CVS Health Editorial boards UpToDate; Best Doctors

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