Ask The Doctor: Rheumatoid Ar... Health Article

Robert Shmerling, M.D., is associate physician and clinical chief of rheumatology at Beth Israel Deaconess Medical Center and an associate professor in medicine at Harvard Medical School. He is an active teacher in the Internal Medicine Residency Program, serving as the Robinson Firm Chief. He is also a teacher in the Rheumatology Fellowship Program and has been a practicing rheumatologist for over 25 years.

Question:

Is there any connection between rheumatoid arthritis and alcohol consumption? Does a prior history of waterborne hepatitis predispose a person to RA?

Answer:

There is no clear connection between rheumatoid arthritis (RA) and alcohol consumption. More specifically, alcohol intake does not clearly affect the risk of developing rheumatoid arthritis and alcohol intake (or lack of it) has no known effect on people who already have RA. Based on what is known about how RA develops and the biology of the condition, there is no reason to expect any connection between the disease and alcohol consumption.

Having said that, at least three studies have evaluated the effect of alcohol consumption on the risk of developing RA among women; each came to a different conclusion. One study found no effect, one found that high alcohol intake (at least two drinks per day) was associated with a lower risk of RA among post-menopausal women, and the last study found that among young women, those consuming at least one alcoholic beverage per day had a 50 percent reduction in the risk of RA. None of these studies was able to establish that alcohol intake actually caused the change in the risk of RA; there could be other potential explanations for these mixed findings. For example, people with joint pain due to RA may change their alcohol intake because they are socializing less or are taking medicines that could interact with alcohol; as a result, people without RA might appear to drink more than those with the disease, falsely suggesting a protective effect of alcohol.

I could find no well-designed study evaluating the effect of alcohol intake on established RA. While it's possible that a connection exists that has not yet been discovered, this much is clear: alcohol consumption can be risky for people with RA taking methotrexate or other medications that can harm the liver. In fact, people with RA are typically advised to avoid alcohol intake completely if they are taking methotrexate.

Similarly there is no clear association between "waterborne hepatitis" (presumably referring to hepatitis A) and RA. Hepatitis A is a common virus that is spread through contaminated food or water and may cause outbreaks of hepatitis (liver inflammation), especially when restaurant workers or others who handle food are infected. Infection is more common wherever there is crowding, inadequate sanitation or poor hygiene. Common symptoms may include fatigue, nausea, loss of appetite and fever; occasionally, joint pain develops, but it resolves within days or weeks and the infection is not a known trigger or risk factor for RA.

Other forms of viral hepatitis (including hepatitis B and C) can also cause joint pain and even joint swelling that can mimic RA; for this reason, liver function tests and antibody tests for these viruses are often checked when the diagnosis of RA is under consideration. However, hepatitis B and C are not typically spread by contaminated water.

The one type of arthritis that is clearly affected by alcohol intake is gout. Gout is caused by uric acid crystals depositing in joints, and alcohol intake increases the amount of uric acid in the body. As a result, many people with gout notice that alcohol can trigger an attack.