Background Alcohol consumption in Rheumatoid arthritis (RA) patients can have several implications including potential effect on treatment such as methotrexate and also risk of enhanced liver toxicity. This is theoretical risk with no evidence base. Use of alcohol in more than moderate quantity can also have direct effects on musculoskeletal health including risk of osteoporosis. There are no clear guidelines on safe limit of alcohol consumption for patients with RA. Available guidance ranges from advising complete abstinence to drinking only in moderation.
Objectives This survey of RA patients on methotrexate treatment was conducted to gain insight into how patients interpret the available guidance and use it in their day-to-day life.
Methods An anonymous questionnaire based survey was conducted in patients with RA attending a rheumatology clinic. The questionnaire was developed by a multidisciplinary rheumatology team in consultation with patient representatives.
Results A total of 200 patients completed the survey over a period of 6 months of which 129 (65.5%) were females, with age distribution of 2% (<20 years), 17.5% (21-40 years), 48% (41-60 years) and 32.5% (>60 years).
Of the total 200 patients, 127 (63.5%) drank alcohol. 89% (113/127) of those who drank alcohol did it for enjoyment whereas 23.6% of patients answered that they drank to cope with their arthritis. Most popular drink was wine (54.3%) followed by beer (31.5%), spirits (26.8%) and others (4.7%). In terms of units, 71.7% (91/127) had <10 units per week, 22% (28/127) had 11-20 units per week
76% (54/71) of male patients drank alcohol as compared to 56.5% (73/127) female patients. There was a difference in alcohol consumption in people based on employment status with 70.8% (68/96) of those in employment drinking alcohol as compared to 56.7% (59/104) of those who were unemployed.
Interestingly 56.5% (113/200) thought it was safe to drink while on methotrexate. On the other hand, 29.1% said that they had missed taking methotrexate as they wanted to have a few drinks.
In terms of number of units, 55.8% thought that <10 units/week is safe to drink with methotrexate, 36.3% felt that 11-20 units were safe, 6.2% felt 20-30 units were safe while 1.7% felt that >30 units were safe.
There was no link between smoking status and alcohol intake.
In this survey, it appears that alcohol intake is higher in male patients and in those who are in employment. There was no significant difference in alcohol intake with age, duration of disease and educational status.
Importantly, 33% patients felt that it was not safe to drink alcohol with methotrexate but they still drank alcohol while on methotrexate.
Conclusions This survey gives us useful insight into patient’s perceptions on safety of alcohol while on treatment with methotrexate. There is lack of clear evidence based guidelines about safety of alcohol use in patients with RA who take methotrexate. It is important to have consistency in guidelines or recommendations to help patients make informed lifestyle choices. This also raises the question whether there is a need for a separate guidance for patients who take methotrexate as compared to general population.
Disclosure of Interest None Declared
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