Jack, I like your common sense approach at the end of this piece. Would just like to make a few comments: -No one has ever studied how much alcohol is safe in a large population of RA pts taking MTX. No one ever will. There is likely to be a huge bell shaped curve depending on both MTX and alcohol dehydrogenase enzyme levels in individuals. That is, some pts can get away with a lot of EtOH, and some will be nailed to the wall. -Nyfors described a 26% incidence of cirrhosis of the liver in Scandanavian psoriatics on MTX. Nyfors associated alcohol intake with the Cirrhotic event. This was published in the Arch of Derm in 1973. I can get you the exact reference if you want. (It may have been Acta Dermatologica Scandanavia) Anyway, when we wrote the guidelines they were based upon serial annual liver biopsies in patients who were forbidden to drink any EtOH. Over a period of 11 yrs, the histology and EM of the livers improved on MTX! And, Yes, we didn't have a control group, but those results were not expected.