In Rheumatology

People taking a common rheumatoid arthritis (RA) medicine are not at increased risk of liver damage if they stick to 14 units of alcohol a week or fewer, a new study from the University of Manchester has found.

Methotrexate is a drug taken, often over long periods of time, to limit or prevent joint damage and disability. People who take methotrexate are often advised to abstain from alcohol as both methotrexate and alcohol are known to increase the risks of liver damage. However, it’s not known whether drinking modest amounts of alcohol is safe during methotrexate therapy.

The new study by the University of Manchester, published in the journal, Annals of the Rheumatic Diseases, and funded by Arthritis Research UK, has drawn upon the medical records of almost 12,000 people with rheumatoid arthritis taking the drug who had a record of the levels of alcohol they drank and who had routine blood monitoring test results.

The researchers found that increased use of alcohol did indeed correspond to increased liver damage, but at 14 units or fewer there was no heightened risk.

Dr Natalie Carter, Head of Research Liaison and Evaluation at Arthritis Research UK, said, ‘We know that methotrexate can be an effective drug for treating arthritis. As it can interact with other medicines and alcohol it is important that people with arthritis have information about their medication in order to manage their arthritis safely and effectively.’

Dr Jenny Humphreys, an NIHR Clinical Lecturer at the University of Manchester’s Arthritis Research UK Centre for Epidemiology, who led the study, commented, ‘In the past there’s not been clear guidance on what effects different amounts of alcohol have on these people, so doctors often err on the side of caution and recommend abstinence.

‘As a result, some people choose to decline methotrexate so they can continue to enjoy a drink, thereby missing out on the possible benefits of the medication. Alternatively, some people may go totally without alcohol after starting methotrexate: if they like to drink in moderation, the quality of their life may be affected.’

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