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RA, Smoking, and Alcohol

The potential risks smoking and drinking pose to people with rheumatoid arthritis.

Health Problems From Smoking and RA continued...

The bottom line: Quit. But Goodman says she doesn't always address that first.

When patients come into her office for treatment, Goodman first focuses on getting their pain under control. After that, she then turns to their bad habits -- like smoking.

"Certainly, everyone should quit smoking," Goodman says. “And we try to help the patient do that.”

Ruthberg takes a harder stance.

"I don't smoke myself," he says, "and I don't much like smoking. My father died of lung cancer, so it doesn't take much for me to discourage anyone who smokes from smoking. But I usually talk about other health risks associated with smoking, like heart attacks and strokes."

Do Alcohol and RA Medications Mix?

The lines between rheumatoid arthritis and drinking are blurrier. Alcohol doesn't promote or help cause RA like smoking does. But mixing alcohol and medications can lead to liver problems.

Some studies have found that drinking in moderation may help lower the chance and the symptoms of rheumatoid arthritis. A study published online in Rheumatology in July 2010 found that drinking alcohol more than 10 days a month decreases "both risk and severity" of the disease. The study was based on information collected from patients about their drinking habits, which doesn’t prove drinking alcohol counters RA or its effects.

"We don't spend very much time encouraging people to drink alcohol," Moore says, "and all things being considered, we are using drugs that have hepatotoxicity [are toxic to the liver] as part of the patients' regimens."

The drug he's talking about is methotrexate, a common RA medication. Mixing alcohol and RA medications like methotrexate, in particular, is risky. Plus, he says he'd like to see more information, like how much alcohol and what kinds -- whether liquor, beer, or wine -- helped people more before he'd suggest to his patients who have mild forms of RA that they might benefit from drinking alcohol.

Methotrexate, like many other medications, is metabolized by the liver. And that's often where the dangers of drinking and medication mixing come into play.

Arava, which goes by the generic name leflunomide, is a companion drug to methotrexate. Moore says he won't offer his patients either unless they agree to stop drinking completely or at least curtail their use of alcohol.

Some patients also use over-the-counter drugs such as acetaminophen, found in many pain relievers and other medications, to help control their pain. Acetaminophen at doses higher than recommended can also cause liver damage.

Physicians keep an eye on their patients' liver functions through regular blood work that monitors liver enzymes. They can sometimes diagnose liver damage caused by both the medications and alcohol.

RA and Drinking

The bottom line: If you're wondering how much you can drink, talk to your doctor.

"Each rheumatologist is different about where they draw the line in the sand about how much they'll let their patients drink," Ruthberg says.

For his patients to stay on methotrexate, Ruthberg allows them no more than a few drinks per week.

Moore asks his patients to keep their drinking to a minimum. And drug interactions aren't the only reason he suggests this.

Limiting alcohol, he says "is once again in respect to different things like obesity, alcohol issues, and accidents. For patients with RA, they may have problems with falling or less control with their hands. And alcohol may complicate that aspect of RA.

"For the type of practice that I have here at Georgia Heath Sciences University, we are really managing patients with more severe disease, more progressive disease. We’re in the fight of our lives to preserve their joints. To do anything to compromise these medicines, I would really be reluctant to do that."

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Reviewed on June 18, 2013

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