Black is most definitely the color of the Irish national drink. Well – black with a creamy head, anyway. Testament to the power of advertising is the number of patients here who still believe the old ad ‘Guinness is good for you’.
Being a reformed teetotaler, I have always tended to err on the side of being rather severe in my warnings about the perils of drink for patients with Rheumatoid or Psoriatic arthritis, particularly if they are taking Methotrexate. The other poor souls who have had to endure my sermonizing include those who are unfortunate enough to have gout.
As a doctor who purports to practice ‘evidence based medicine’ it is always reassuring when the evidence base backs up the ’eminence based medicine’ I’ve been practicing for 10 or 20 years. On the other hand it is frankly a bit upsetting when I am forced to eat my oft-repeated words of solemn advice. So here are three ‘factoids’ I’m currently pondering – not exactly proof positive, but some interesting observations at least.
- Factoid #One – Drinking alcohol seems to be protective against Rheumatoid Arthritis. This idea has been around since a Seattle study by Voigt and colleagues reported in Epidemiology in 1994. This paper suggested that you were about half as likely to get RA if you drank over 14 drinks a week of alcohol – the authors suggested that could be because alcohol raised Estrogen levels;
More recently (2010), a Sheffield study by Maxwell and colleagues reported in Rheumatology seemed to confirm that observation. So what are we to make of that? Infusions of Guinness in our day ward, anyone? Unfortunately, alcohol does not seem to reverse the disease once started!
- Factoid #Two – The risk of liver function test abnormalities in patients who take lowish doses of Methotrexate does not seem to be increased in ‘social alcohol’ drinkers. So said Tilling L and colleagues in 2006. Chris Deighton (2008) seemed to agree, and the BSR guidelines have relaxed the advice about alcohol intake in patients taking Methotrexate. However, this idea is being whispered very softly at the moment, and I think it is right to be cautious until we have more studies to confirm this. Whatever we might think and say, it is quite clear that many patients don’t pay a blind bit of notice to the advice they are given on this subject.
- Factoid #Three – Not all types of alcohol are bad for patients with gout. One of several excellent studies on gout by HK Choi published in the Lancet in 2004 suggests that whilst beer is bad for gout, wine is not. I doubt very much if Guinness featured among his survey’s favorite tipples, so I guess my patients are still existing in an evidence free zone! Nevertheless, I still advise them to cut down on the beer intake. Old habits die hard.