Smoking, Drinking, and RA

Is it safe to smoke or drink if you have RA? Smoking is a very bad idea for anyone with rheumatoid arthritis. It’s also an unhealthy habit that puts your heart and lungs at risk.

The occasional wine, beer, or cocktail may be OK for people with RA. But the amount you drink each day or week matters.

There’s a Link Between Smoking and RA

Lighting up makes you more likely to get RA even if you haven’t been a heavy smoker. The more you smoke, the higher your chances go. Cigarettes can make your RA more severe.

Smoking boosts inflammation, and RA involves inflammation that’s out of control because your immune system attacks your own healthy tissues by mistake. Your synovium, the tissue that lines your joints, can get inflamed and thickened. Tobacco smoke includes lots of nasty substances like free radicals. They put stress on your body and can trigger inflammation.

Smokers have higher levels of inflammatory proteins called cytokines in their body. These play a role in the joint and organ damage that comes with RA. Tobacco smoke causes your body to release all kinds of cytokines linked to inflammation in RA.

Smoking may also cause your body to make anti-CCP antibodies. These can lead to more severe RA in people with a gene called HLA-DRB1.

Smoking Can Make RA Worse

Smokers with RA have a more active disease process than those who never smoked or have stopped smoking. High disease activity in RA often equals swollen or tender joints, signs of high inflammation in your blood, or more joint pain.

Active disease in RA leads to joints that don’t work as well. They can become stiff, bent, or damaged. You may even need surgery to repair or replace them down the road.

Your Meds May Not Work as Well

Smokers with RA don’t respond as well to many RA treatments.

They’re less likely to be able to get into remission, which means their disease activity is very low. They usually have worse RA-related symptoms because their drugs just don’t work as well.

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It Can Lead to Complications

Inflammation can cause heart disease, so you’re already more likely to get it if you have RA. If you smoke, too, your odds go even higher.

If you have RA, don’t smoke. If you do smoke, talk to your doctor about quitting. He can suggest treatments and put you in touch with counseling or support groups that may help you kick the habit.

Can You Drink if You Have RA?

If you enjoy beer, wine, or a mixed drink now and then, it may be good for you even if you have RA. The catch: You need to limit how much you drink.

You could lower your risk of heart disease or even death if you’re a light to moderate drinker, even more than if you don’t drink at all. That’s true even if you take methotrexate, a common RA treatment.

What’s moderate drinking? It’s only about one small drink per day for women and two drinks per day for men. That’s about 14 grams of alcohol per drink, since every type of drink has other ingredients too, such as water or sugar.

Drink sizes really vary, but standard servings of alcohol are:

  • 12 ounces of beer
  • 8 ounces of malt liquor
  • 5 ounces of wine
  • 1.5 ounces of liquor or whiskey

It Can Affect Some Meds

Talk to your doctor before you open your liquor cabinet. If you take some RA medications, such as leflunomide (Arava), you shouldn’t drink at all. Drinking while you take some OTC pain drugs, such as ibuprofen, naproxen sodium, or acetaminophen, raises your risk of stomach or liver damage.

Alcohol and Inflammation

Light to moderate amounts of alcohol may lower the level of some of those cytokines that cause inflammation. But heavy alcohol use can raise it. Too much drinking can also make you more likely to get some types of cancer or diabetes.

But drinking isn’t an RA treatment. If you have RA, the best way to stay healthy and protect your joints is to stick to your treatment plan, exercise, stay at a healthy weight, and avoid smoking.

WebMD Medical Reference Reviewed by David Zelman, MD on February 25, 2019

Sources

SOURCES:

Mayo Clinic: “Smoking and Rheumatoid Arthritis: What’s the risk?”

Arthritis Foundation: “Alcohol and Arthritis.”

Arthritis Research and Therapy: “Cigarette smoking and risk of rheumatoid arthritis: a dose-response meta-analysis.”

Annals of the Rheumatic Diseases: “Association between rheumatoid arthritis disease activity, progression of functional limitation and long-term risk of orthopaedic surgery: combined analysis of two prospective cohorts supports EULAR treat to target DAS thresholds,” “Impact of smoking as a risk factor for developing rheumatoid arthritis: a meta-analysis of observational studies.”

International Journal of Molecular Sciences: “Smoking and Rheumatoid Arthritis.”

Journal of Rheumatology: “Smoking, Smoking Cessation, and Disease Activity in a Large Cohort of Patients with Rheumatoid Arthritis.”

National Rheumatoid Arthritis Society: “Leflunomide,” “The DAS-28 Score.”

Clinical Rheumatology: “Current smoking status is associated to a non-ACR 50 response in early rheumatoid arthritis. A cohort study.”

Jamaica Hospital Medical Center: “Smoking and Rheumatoid Arthritis.”

American Heart Journal: Rheumatoid Arthritis and Cardiovascular Disease.”

CDC: “Alcohol and Public Health: Frequently Asked Questions,” “Fact Sheets: Alcohol Use and Your Health,” “Quitting Smoking.”

ACR Meeting Abstracts: “Alcohol Consumption and the Risk of Coronary Heart Disease and Mortality in Patients with Rheumatoid Arthritis.”

Arthritis & Rheumatology: “Alcohol consumption and markers of inflammation in women with preclinical rheumatoid arthritis.”

National Institute on Alcohol Abuse and Alcoholism: “What Is a Standard Drink?”

The Lancet: “Effect of alcohol consumption on systemic markers of inflammation.”

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