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A recent RheumNow survey of 495 rheumatologists found that half of rheumatologists allow 1-3 alcoholic drinks per week and 6-7% has no alcohol restrictions while being treated with methotrexate (MTX). Conversely ~25% only allowed 1-3 drinks per month and 15-20% forbid any alcohol use.
Despite these beliefs, there is limited data to support the practices of many.
Humphries et al from Manchester compared and quantified the intake of alcohol and the the risk of developing abnormal liver blood tests (LFTs) using data from the Clinical Practice Research Datalink (between 1987 and 2016).
For this study, hepatotoxicity was defined as transaminitis (alanine transaminase or aspartate aminotransferase levels) more than three times the upper limit of normal.
From 11,839 RA patients on MTX, there were 530 episodes of transaminitis occurring in 47 090 person-years follow-up.
An increased risk of transaminitis, was only observed for those patients consuming between 15 and 21 units per week (HR 1.01l 95% CI, 1.00 to 1.02). Those drinking >21 units per week significantly increased rates of transaminitis by 85% (adjusted HR 1.85; 1.17 to 2.93).
However, these data are lacking details, such as the frequency of testing, the number of patients with repeated "transaminitis", other evidence of liver dysfunction and lastly, the consequences of such tranasminitis.
Overall, the investigators surmised that <14 units per week of alcohol consumed was associated with a low rate of transamnitis and that evidence of liver damage does rise with higher levels of consumption.
These findings are somewhat reassuring to the nearly 75% of Rheumatologists who permit lesser levels of alcohol in their patients receiving MTX therapy.