NEW YORK (Reuters Health)—In patients taking methotrexate for rheumatoid arthritis (RA), moderate alcohol consumption – that is, no higher than existing U.K. guidelines for the general population – was not associated with an increased risk of transaminitis, researchers say.
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The study is both the largest to examine alcohol and methotrexate (MTX) and the first to look at how the amount of alcohol affects hepatotoxicity in patients taking long-term MTX, corresponding author Dr. William G. Dixon, of the University of Manchester, told Reuters Health by email.
Although the risk of transaminitis in patients with RA taking MTX was found to increase with increasing alcohol consumption, the risk in those patients who consumed no more than 14 units of alcohol per week was no greater than in those who do not drink alcohol, the researchers reported online March 23 in Annals of the Rheumatic Diseases.
U.K. guidelines recommend the consumption of no more than 14 units of alcohol per week, by men or women. A “unit” of alcohol is defined as 10 ml or 8 g of pure alcohol.
Fourteen units of alcohol equals six pints of 4% beer, six glasses of 13% wine, or 14 (25 ml) glasses of 40% spirits, according to the Drinkaware website.
In comparison, guidelines from the U.S. Centers for Disease Control and Prevention indicate that moderate alcohol use is up to 1 drink for a woman and 2 drinks for a man, on any single day. “Drink” definitions are similar to those used in the United Kingdom.
Their findings, the researchers wrote, “may provide the practical and useful information that drinking alcohol within nationally recommended levels in the UK is safe, in terms of risk of transaminitis, for patients commencing MTX therapy for RA.” Including these acceptable alcohol levels in clinical guidelines and informing patients of them, they added, could improve decision-making, clinical outcomes and overall quality of life.
The current uncertainty, Dr. Dixon said, “means that patients often avoid alcohol altogether, or avoid methotrexate if they want to continue to drink, even modestly.”
The authors cautioned, however, that their findings should not be generalized to other populations. For example, previous research has suggested that patients with psoriasis may have a higher incidence of liver disease compared to patients with RA.
One expert who was not connected to the study raised another caveat. Dr. Joel Kremer, of Albany Medical Center in upstate New York, thinks the study’s threshold for transaminitis – i.e., alanine transaminase or aspartate aminotransferase at least three times the upper limit of normal (ULN) – is much too high.