Beer Drinking And Arthritis: Is There A Link?

Alcohol consumption is a well-known risk factor for various health conditions, including cardiovascular disease and cancer. However, when it comes to arthritis, the relationship is more complex and depends on the type of arthritis, medication, and lifestyle.

For rheumatoid arthritis (RA), an autoimmune and inflammatory disease affecting the joints, some studies suggest that moderate alcohol consumption may reduce the risk of developing RA and alleviate symptoms. This is attributed to alcohol's anti-inflammatory effects and its ability to lower biomarkers of inflammation. However, the mechanisms behind these associations are not yet fully understood, and more research is needed.

On the other hand, alcohol can have negative interactions with medications commonly used to treat arthritis, such as non-steroidal anti-inflammatory drugs (NSAIDs) and disease-modifying antirheumatic drugs (DMARDs). Mixing alcohol with NSAIDs like ibuprofen or naproxen increases the risk of stomach bleeding and ulcers. Alcohol consumption with acetaminophen, methotrexate, or leflunomide can also increase susceptibility to liver damage.

For gout, an inflammatory type of arthritis, alcohol consumption is particularly problematic as it can trigger gout attacks. Beer, distilled liquor, and wine are high in purines, which can increase uric acid levels in the blood and contribute to gout.

While moderate drinking may provide some benefits for people with RA, it is essential to consult a healthcare professional before consuming alcohol, especially when taking arthritis medications. The general recommendation for alcohol consumption is one drink per day for women and two drinks per day for men. However, individuals who do not drink or drink very little should not start or increase their alcohol intake solely for potential arthritis-related benefits.

Alcohol and rheumatoid arthritis

Alcohol's Anti-Inflammatory Effects

Alcohol's anti-inflammatory effects are thought to be one of the reasons it appears to lower cardiovascular disease risk in moderate drinkers. "Moderate alcohol consumption reduces biomarkers of inflammation, including c-reactive protein (CRP), interleukin-6, and TNF-alpha receptor 2," says Karen Costenbader, MD, MPH, a rheumatologist at Brigham and Women's Hospital in Boston.

One study showed that inflammation was lowest in people who drank a moderate amount of alcohol compared to those who drank either more or less. A more recent study showed that alcohol might help with RA through its effect on certain immune cells. The thinking is that moderate amounts of alcohol might help to keep those cells from overreacting and causing inflammation in people with RA.

Alcohol and RA Benefit

There is some evidence that moderate drinking may help prevent RA. A Swedish study that included more than 34,000 women showed that those who drank more than four glasses of alcohol per week were less likely to get RA than women who drank less than one glass of alcohol per week or who never drank. A US study of more than 120,000 female nurses showed that women who drank a beer two to four times a week were about a third as likely to get RA as women who never drank beer.

Medication Interactions

If you already have arthritis, drinking may have more downsides than pluses. Many of the medicines prescribed to relieve sore joints don't mix well with alcohol, including non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Motrin) or naproxen (Aleve), which carry a greater risk for stomach bleeding and ulcers when mixed with alcohol. Taken with acetaminophen, methotrexate or leflunomide (Arava), alcohol can make you more susceptible to liver damage.

Gout Attacks

Alcohol is particularly problematic if you have gout. "Gout attacks can be brought on by purine-rich foods or drinks, and beer is high in purines," says Dr. Costenbader. Distilled liquor, and possibly wine, can also cause problems for those with gout.

Additional Risks

The risk of other diseases goes up with higher alcohol consumption. Conditions linked to drinking more than moderate amounts of alcohol include cancers of the breast, colon, oesophagus, mouth and throat, as well as diseases like diabetes and stroke.

Alcohol and gout

Gout is a type of inflammatory arthritis caused by excess uric acid in the bloodstream. It usually affects only one joint at a time, with the big toe being the most common location for gout crystals to form. Other affected areas can include the ankle, smaller toe joints, and knees.

Alcohol consumption can increase the level of uric acid in the body, and regular alcohol use can increase a person's chances of developing gout. Beer, in particular, is known to have the highest level of purine content and can lead to gout symptoms. A 2021 review of 15 studies found a correlation between gout and beer, as well as distilled spirits.

A 2006 study found that compared to no alcohol consumption, the odds of a gout attack were 1.1, 0.9, 2.0, and 2.5 for 1-2, 3-4, 5-6, and 7 or more drinks consumed over a 2-day period, respectively. The study concluded that alcohol consumption triggers gout attacks, with the effect likely occurring within 24 hours of consumption.

Another study of 724 participants with gout found that moderate amounts of alcoholic beverages, regardless of the type, increased the risk of gout attacks. The study recommended that individuals with gout should limit alcohol intake to reduce the risk of attacks.

Therefore, it is advisable for those with gout to eliminate alcohol from their diet to prevent flare-ups.

Alcohol and osteoarthritis

Osteoarthritis (OA) is the most common type of arthritis, affecting the knees, hips, and spine. The tissues in the joints break down over time, and the severity of the condition depends on the level of pain and how it affects daily activities.

There is conflicting evidence regarding the association between alcohol consumption and osteoarthritis. While some studies suggest that moderate alcohol consumption may have a protective effect against OA, others indicate that alcohol intake is positively associated with the disease.

One study found that wine consumption is a risk factor for knee OA, while beer consumption appears to increase the risk of both knee and hip OA. However, the underlying biological mechanisms are not yet fully understood, and more research is needed to establish a causal relationship.

It is important to note that alcohol consumption can have both positive and negative effects on health. While moderate drinking may reduce the risk of developing OA, excessive alcohol consumption can damage the body in various ways, increasing the risk of diseases such as cancer, diabetes, and stroke.

Additionally, alcohol can interact with medications commonly used to treat OA, such as non-steroidal anti-inflammatory drugs (NSAIDs) and disease-modifying antirheumatic drugs (DMARDs). Mixing alcohol with NSAIDs can increase the risk of stomach bleeding and ulcers, while consuming alcohol with DMARDs can increase the risk of liver damage.

Therefore, it is crucial to consult a healthcare professional before consuming alcohol, especially when taking medications for OA. The current recommendation is to limit alcohol intake to one drink per day for women and two drinks per day for men.

Alcohol and psoriatic arthritis

Alcohol and Psoriasis

Alcohol intake has been associated with an increased risk of psoriasis. Alcohol may influence the immune system in different ways. While acute alcohol exposure is inhibitory, chronic alcohol exposure leads to an increase in inflammatory cell responses. Excessive alcohol consumption contributes to increased levels of several important markers, including tumour necrosis factor (TNF)-α-converting enzyme (TACE) and transforming growth factor (TGF)-α receptor 1, which are involved in systemic immunodysregulation in psoriasis.

There is some evidence to suggest that alcohol intake may be a factor in raising the chances of getting psoriasis, but more research is needed on the link between drinking and psoriatic arthritis. One study suggests women who drink too much alcohol get psoriasis more often than those who don't. Excessive alcohol intake, defined as 30 grams or more per day, was associated with an increased risk of incident psoriatic arthritis in a cohort of US women.

Alcohol and Medication for Psoriatic Arthritis

Alcohol and arthritis medication

Drinking alcohol while taking arthritis medication is not recommended. However, if you are taking medication for arthritis and would like to know your specific options regarding consuming alcohol, you should contact your healthcare provider.

Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)

Nonsteroidal anti-inflammatory drugs (NSAIDs) are frequently used to ease inflammation, pain, and stiffness. They can be rubbed on the skin or taken orally. NSAIDs are often prescribed for people with achy joints and are also used to relieve headaches and reduce fevers. Prescription-strength NSAIDs are associated with an increased risk of gastrointestinal bleeding, which can become worse when combined with alcohol.

Disease-Modifying Antirheumatic Drugs (DMARDs)

Disease-modifying antirheumatic drugs (DMARDs) are used to stop or slow the inflammatory form of arthritis. Each works differently. DMARDs are classified as either conventional or biologic and are primarily used for patients with rheumatoid arthritis (RA) and psoriatic arthritis (PsA). The medication is given as a shot, taken as a pill, or infused into the vein. If a patient has arthritis and is taking DMARDs, they should not consume any type of alcohol as it could increase the risk of liver disease.

Methotrexate

Methotrexate (Trexall, Rheumatrex, Otrexup, Rasuvo) is a medication commonly prescribed for people with RA to reduce pain and swelling and slow the progression of the disease. Historically, people taking methotrexate were advised to abstain from alcohol as the combination increased the risk of hepatotoxicity (liver poisoning) and liver damage. However, a 2017 analysis of 11,813 adults suggested that consuming no more than 14 standard drinks per week may be acceptable for people with no underlying liver problems. The American College of Rheumatology continues to advise against drinking alcohol while taking methotrexate, and prescribing information for the medication notes that the risk of liver toxicity is increased with "heavy alcohol consumption."

Acetaminophen (Tylenol)

Patients taking acetaminophen regularly should be cautious about their alcohol use. For the average healthy adult, the recommended maximum daily dose of acetaminophen is 4,000 milligrams (mg), but in some people, doses close to the 4,000 mg daily limit could still be toxic to the liver. Alcohol causes the liver to convert acetaminophen into more toxic byproducts, so it's important to take the minimal amount of acetaminophen necessary and limit alcohol consumption while taking this medication.

Leflunomide (Arava)

Taking leflunomide with alcohol can make you more susceptible to liver damage.

Frequently asked questions