Low-to-Moderate Alcohol Consumption May Be Safe When Taking Methotrexate for Rheumatoid Arthritis or Psoriasis


It is unclear if consumption of small to moderate amounts of alcohol is safe while taking methotrexate. We set out to determine whether there is an association between liver enzyme abnormalities and alcohol consumption in subjects taking methotrexate. The study sample was identified from the database of the South Central Veteran Affairs Healthcare Network, consisting of 10 hospitals in Texas, Oklahoma, Mississippi and Louisiana. From a cohort of 2443 eligible Veterans with rheumatoid arthritis and/or psoriasis taking methotrexate from 10/1/2007 to 9/30/2009, 120 cases with abnormal liver-enzyme elevation were randomly selected to compare with 120 controls. Data were collected from mailed survey forms that inquired about alcohol consumption habits, physicians’ advice on alcohol, and methotrexate compliance. There was no significant difference in the number of non-drinkers and low-to-moderate alcohol drinkers between cases and controls (p = 0.217). Few persons identified themselves as heavy drinkers. Our data suggest that it is likely safe for patients with rheumatoid arthritis and psoriasis to consume low-to-moderate amounts of alcohol while taking methotrexate. However, alternative methods to improve capturing alcohol consumption in heavy drinkers are needed for more comprehensive results.

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B. Ng, "Low-to-Moderate Alcohol Consumption May Be Safe When Taking Methotrexate for Rheumatoid Arthritis or Psoriasis," Open Journal of Rheumatology and Autoimmune Diseases, Vol. 2 No. 3, 2012, pp. 39-46. doi: 10.4236/ojra.2012.23009.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] [1] Office of Applied Studies, “Alcohol Use among Veterans,” Office of Applied Studies, Rockville, 2001.
[2] Office of Applied Studies, “Gender Differences in Alcohol Use and Alcohol Dependence or Abuse: 2004 and 2005,” Office of Applied Studies, Rockville, 2007.
[3] R. S. Stern, T. Nijsten, S. R. Feldman, et al., “Psoriasis Is Common, Carries a Substantial Burden Even When Not Extensive, and Is Associated with Widespread Treatment Dissatisfaction,” Journal of Investigative Dermatology Symposium, Vol. 9, No. 2, 2004, pp. 136-139. doi:10.1046/j.1087-0024.2003.09102.x
[4] C. G. Helmick, D. T. Felson, R. C. Lawrence, et al., “Estimates of the Prevalence of Arthritis and Other Rheumatic Conditions in the United States. Part I,” Arthritis & Rheumatism, Vol. 58, No. 1, 2008, pp. 15-25. doi:10.1002/art.23177
[5] T. Nijsten, D. J. Margolis, S. R. Feldman, et al., “Traditional Systemic Treatments Have Not Fully Met the Needs of Psoriasis Patients: Results from a National Survey,” Journal of the American Academy of Dermatology, Vol. 52, No. 3, 2005, pp. 434-444.
[6] J. M. Kremer, G. S. Alarcon, R. W. Lightfoot Jr., et al., “Methotrexate for Rheumatoid Arthritis. Suggested Guidelines for Monitoring Liver Toxicity. American College of Rheumatology,” Arthritis & Rheumatism, Vol. 37, No. 3, 1994, pp. 316-328. doi:10.1002/art.1780370304
[7] C. Salliot and D. van der Heijde, “Long Term Safety of Methotrexate Monotherapy in Rheumatoid Arthritis Patients: A Systematic Literature Research,” Annals of the Rheumatic Diseases, Vol. 68, No. 7, 2008, pp. 1100-1104.
[8] S. Rajakulendran and C. Deighton, “Do Guidelines for the Prescribing and Monitoring of Leflunomide Need to Be Modified?” Rheumatology, Vol. 43, No. 11, 2004, pp. 1447-1448. doi:10.1093/rheumatology/keh348
[9] C. L. Bryson, D. H. Au, H. Sun, et al., “Alcohol Screening Scores and Medication Nonadherence,” Annals of Internal Medicine, Vol. 149, No. 11, 2008, pp. 795-804.
[10] J. Dunbar-Jacob, J. L. Holmes, S. Sereika, et al., “Factors Associated with Attrition of African Americans during the Recruitment Phase of a Clinical Trial Examining Adherence among Individuals with Rheumatoid Arthritis,” Arthritis & Rheumatism, Vol. 51, No. 3, 2004, pp. 422-428. doi:10.1002/art.20411
[11] S. Rajakulendran, K. Gadsby and C. Deighton, “Rheumatoid Arthritis, Alcohol, Leflunomide and Methotrexate. Can Changes to the BSR Guidelines for Leflunomide and Methotrexate on Alcohol Consumption Be Justified?” Musculoskeletal Care, Vol. 6, No. 4, 2008, pp. 233-245. doi:10.1002/msc.135
[12] US Department of Health and Human Services, “Helping Patients Who Drink Too Much: A Clinician’s Guide,” NIAAA Publications Distribution Center, Rockville, 2005, p. 24.
[13] M. C. Dufour, “What Is Moderate Drinking? Defining ‘Drinks’ and Drinking Levels,” Alcohol Research & Health, Vol. 23, No. 1, 1999, pp. 5-14.
[14] K. Visser and D. M. Van der Heidje, “Incidence of Liver Enzyme Elevations and Liver Biopsy Abnormalities during Methotrexate Treatment in Rheumatoid Arthritis: A Systematic Review of the Literature,” Arthritis & Rheumatism, Vol. 58, 2008, p. S557.
[15] R. E. Kalb, B. Strober, G. Weinstein, et al., “Methotrexate and Psoriasis: 2009 National Psoriasis Foundation Consensus Conference,” Journal of the American Academy of Dermatology, Vol. 60, No. 5, 2009, pp. 824-837. doi:10.1016/j.jaad.2008.11.906
[16] R. A. Bright, J. Avorn and D. E. Everitt, “Medicaid Data as a Resource for Epidemiologic Studies: Strengths and Limitations,” Journal of Clinical Epidemiology, Vol. 42, No. 10, 1989, pp. 937-945. doi:10.1016/0895-4356(89)90158-3
[17] J. P. Burke, H. H. Tilson and R. Platt, “Expanding Roles of Hospital Epidemiology: Pharmacoepidemiology,” Infection Control and Hospital Epidemiology, Vol. 10, No. 6, 1989, pp. 253-254. doi:10.1086/646016
[18] I. K. Crombie, “The Role of Record Linkage in Post- Marketing Drug Surveillance,” British Journal of Clinical Pharmacology, Vol. 22, No. 1, 1986, pp. 77S-82S. doi:10.1111/j.1365-2125.1986.tb02987.x
[19] G. A. Faich, “Record Linkage for Postmarketing Surveillance,” Clinical Pharmacology and Therapeutics, Vol. 46, No. 4, 1989, pp. 479-480. doi:10.1038/clpt.1989.169
[20] W. A. Ray and M. R. Griffin, “Use of Medicaid Data for Pharmacoepidemiology,” American Journal of Epidemiology, Vol. 129, No. 4, 1989, pp. 837-849.
[21] S. Shapiro, “The Role of Automated Record Linkage in the Postmarketing Surveillance of Drug Safety: A Critique,” Clinical Pharmacology and Therapeutics, Vol. 46, No. 4, 1989, pp. 371-386. doi:10.1038/clpt.1989.154
[22] H. H. Tilson, “Pharmacoepidemiology: The Lessons Learned; the Challenges Ahead,” Clinical Pharmacology and Therapeutics, Vol. 46, No. 4, 1989, p. 480. doi:10.1038/clpt.1989.170
[23] E. J. Boyko, T. D. Koepsell, J. M. Gaziano, et al., “US Department of Veterans Affairs Medical Care System as a Resource to Epidemiologists,” American Journal of Epidemiology, Vol. 151, No. 3, 2000, pp. 307-314. doi:10.1093/oxfordjournals.aje.a010207
[24] J. A. Singh, A. R. Holmgren and S. Noorbaloochi, “Accuracy of Veterans Administration Databases for a Diagnosis of Rheumatoid Arthritis,” Arthritis Care & Research, Vol. 51, No. 6, 2004, pp. 952-957. doi:10.1002/art.20827
[25] J. A. Singh, A. R. Holmgren, H. Krug, et al., “Accuracy of the Diagnoses of Spondylarthritides in Veterans Affairs Medical Center Databases,” Arthritis Care & Research, Vol. 57, No. 4, 2007, pp. 648-655. doi:10.1002/art.22682

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