How Drinking Can Affect Your Psoriatic Arthritis
If you have psoriatic arthritis (PsA), you may be wondering if you should give up your nightly glass of wine or your weekend cocktails. Well, that depends. There actually haven’t been a whole lot of studies on the relationship between alcohol and psoriasis, and even fewer on alcohol and psoriatic arthritis (PsA). To help you weigh the risks of drinking when you have PsA, here’s an overview of what experts know about the relationship between the two right now.
Research Is Cloudy, But There Are Helpful Takeaways
Take for instance a recent review that looked at the available research on alcohol and psoriasis. The scientists concluded that “more research is needed” to get a better handle on whether alcohol does indeed trigger or worsen psoriasis and if so, how much alcohol it takes. (We know. Super helpful.) That said, other studies have found several links between drinking, psoriasis, and PsA, especially where medication is concerned, so there is some evidence that alcohol could potentially have negative effects.
If You Have Psoriasis, Alcohol Could Up Your Risk for PsA
A 2020 study in The British Journal of Dermatology (BJD) investigated whether factors such as obesity, smoking, and drinking put people with psoriasis at a higher risk for developing PsA. They found that having up to three drinks per day increased the odds by 57%. But this isn't a guarantee, notes Brett Smith, D.O., a rheumatologist at Blount Memorial Physicians Group in Alcoa, TN. Plus, “you can do everything ‘right’ by maintaining a normal BMI, not smoking and not drinking, and still develop a rheumatic disease,” Dr. Smith says.
Drinking May Worsen Your Quality of Life
Alcohol is a potential trigger for flare-ups because it increases inflammation, particularly in your joints. "Alcohol can also make patients more tired, have more pain, and become less functional,” says Shaiba Ansari-Ali, M.D., a rheumatologist at Northwestern Medicine Central DuPage Hospital in Winfield, IL. Plus, the extra calories can increase your weight over time, potentially escalating inflammation, Dr. Smith adds. If you notice that your PsA symptoms get worse after drinking, try tracking your alcohol intake and symptoms to see for sure. Simply cutting back may make a difference.
Alcohol Could Further Raise Your Heart-Disease Risk
Heavy drinking can make you more prone to metabolic syndrome, a group of conditions that puts you at higher risk for heart disease. Both heart disease and metabolic syndrome are already more common in PsA patients anyway, thanks to underlying inflammation, says Dr. Ansari-Ali. So while an occasional drink may be fine, you could be increasing your risk for heart disease and other health problems later on if you regularly overdo it.
Drinking May Interfere With Your Medication
Alcohol may reduce your medication’s effectiveness, which could decrease your response to treatment, according to the National Psoriasis Foundation. Drinking can also increase your risk of side effects. For instance, consuming alcohol when you’re taking something as seemingly harmless as over-the-counter pain relievers like aspirin, Tylenol (acetaminophen) or Advil (ibuprofen) ups your chances of having a faster heartbeat, upset stomach, bleeding, and stomach ulcers.
You Shouldn’t Drink at all With Certain Medications
Experts do know for sure that alcohol can lead to serious issues when you’re taking specific medications. Avoid alcohol altogether if you’re on one of the most common types of disease-modifying antirheumatic drugs (DMARDs) like Otrexup or Trexall (methotrexate), Azulfidine (sulfasalazine) or Arava (leflunomide), advises Dr. Smith. Why? The explanation is coming up next.
Alcohol Can Contribute to Liver Damage
First off, having PsA increases your risk for nonalcoholic fatty-liver disease (NAFLD), or “fatty liver.” NAFLD can eventually cause cirrhosis, which is scarring. Second, many PsA medications are processed through the liver; if you have NAFLD, too, “this ‘double hit’ can lead to more liver damage,” Dr. Ansari-Ali says. Adding alcohol to the mix is a potential triple whammy. “You could have NAFLD and normal liver function on blood tests, but over time, alcohol consumption can scar the liver permanently, especially in combination with various medications,” says Dr. Smith.
What’s Best for You May Not Be What’s Best for Another PsA Patient
As you can see, the evidence isn’t exactly crystal clear on precisely how alcohol contributes to or affects PsA. “Complete avoidance of alcohol is not necessarily needed, but it does depend on each individual’s circumstance,” Dr. Smith says. Weighing the benefits and risks may help if you’re trying to make a decision. For instance, if alcohol is clearly making your symptoms worse, you already have heart or liver disease, or you’re taking certain medications, it might be reasonable to teetotal. Cutting back can also help if you're trying to lose weight.
Wondering if You Should Make a Change? Ask Your Doctor
Don’t forget to let your rheumatologist weigh in. They may have some valuable insight on your unique health challenges and needs, plus they can answer questions and give you other resources to help if you think you need to quit for good, especially if you’re having a hard time.
Limited Studies: National Psoriasis Foundation. (2015). “How cigarettes and alcohol affect psoriasis.” psoriasis.org/advance/how-cigarettes-and-alcohol-affect-psoriasis
Psoriasis and Alcohol Review: Psoriasis: Targets and Therapy. (2019). “Psoriasis and alcohol.” ncbi.nlm.nih.gov/pmc/articles/PMC6709030/
Risk Factors for PsA: The British Journal of Dermotology. (2020). “Modifiable risk factors and the development of psoriatic arthritis in people with psoriasis.” onlinelibrary.wiley.com/doi/full/10.1111/bjd.18227
PsA Triggers: Rheumatoid Arthritis Support Network. (2018). “Psoriatic Arthritis: Which Foods are Triggers and Which are Suppressants?” rheumatoidarthritis.org/psoriatic-arthritis/diet/
Heavy Drinking and Metabolic Syndrome: Cedars-Sinai. (2020). “Metabolic Syndrome: Who is at risk for metabolic syndrome?” cedars-sinai.org/health-library/diseases-and-conditions/m/metabolic-syndrome.html
Heart Disease, Metabolic Syndrome and NAFLD in PsA: Arthritis Foundation. (n.d.). “Metabolic Comorbidities of Psoriatic Arthritis.” arthritis.org/health-wellness/about-arthritis/related-conditions/other-diseases/metabolic-comorbidities-of-psoriatic-arthritis
Medication Effectiveness and Alcohol: National Psoriasis Foundation. (2015). “How cigarettes and alcohol affect psoriasis.” psoriasis.org/advance/how-cigarettes-and-alcohol-affect-psoriasis
Medication Side Effects and Alcohol: National Institute on Alcohol Abuse and Alcoholism. (2014). “Harmful Interactions: Mixing Alcohol With Medicines.” niaaa.nih.gov/publications/brochures-and-fact-sheets/harmful-interactions-mixing-alcohol-with-medicines
NAFLD: Mayo Clinic. (2019). “Nonalcoholic fatty liver disease.” mayoclinic.org/diseases-conditions/nonalcoholic-fatty-liver-disease/symptoms-causes/syc-20354567
Methotrexate and Liver Damage: Medline Plus. (2020). “Methotrexate: Important Warning.” medlineplus.gov/druginfo/meds/a682019.html