Does Having PSA Mean You Should Give Up Alcohol Completely?

Avoiding alcohol could minimize inflammation and possibly reduce flares. Ultimately, you have the freedom to decide how much alcohol you choose to consume.

A few years ago, I found some very convincing evidence that there might be a correlation between psoriatic arthritis (PsA) and microbiome health. That led me down a circuitous path into the world of inflammatory foods, and how I might be able to control flares with lifestyle changes.

For 2 months, I cut out red meat, sugar, white flour, corn, dairy, and alcohol. And although this lifestyle change was difficult, I found giving up alcohol to be the most challenging of all. So many social gatherings include alcohol: wine at holiday dinners, champagne at weddings and birthdays, even meeting up with friends for happy hour.

While there’s a lot of credible information about reducing PsA flares by maintaining an anti-inflammatory diet, I struggled with this nagging question: if you have PsA, do you need to completely avoid alcohol?

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What we know

While there’s no conclusive evidence that alcohol consumption increases PsA symptoms, studies do suggest a link between alcohol consumption and the “prevalence” of PsA.

This may be because drinking alcohol is so common and so socially sanctioned, but it’s worth exploring the possible connections. After all, PsA is an inflammatory disease, and consumption of alcohol can cause inflammation in the gut microbiome.

Inflammation in the bowel is also linked to an increase in cytokines, part of the inflammatory response that is an important part of a healthy immune system. But with PsA (and other inflammatory diseases) cytokines get overproduced. So theoretically, avoiding alcohol if you have PsA could minimize inflammation and possibly reduce flares.

Many of the studies I explored measure results from individuals who ingest large amounts of alcohol, which we already know isn’t healthy. Heavy alcohol consumption is hard on the liver and kidneys, and might even increase joint pain because of dehydration. Yet aren’t there health benefits to drinking alcohol in small amounts, and red wine in particular?

Possible health benefits 

For a while now, we’ve been hearing that red wine has health benefits. Red wine contains resveratrol, a powerful antioxidant linked in several studies to reducing inflammation, lowering cholesterol, and possibly even minimizing the development of dementia.

However, what’s inconclusive is whether or not those who consume red wine also consume healthier diets, such as the Mediterranean diet, which may account for their improved overall health.

Additional studies also emphasize moderate alcohol consumption, meaning no more than one 5-oz glass of red wine a day, which most people exceed during wine tastings or when sharing a bottle at dinner.

And you don’t need to drink alcohol to consume resveratrol; it’s also found in grapes and berries, which can be part of a healthy, balanced diet. 

Complications with certain medications 

While it may have certain health benefits, even moderate alcohol consumption is detrimental if you take certain medications, such as methotrexate (MTX). MTX, one of the first treatments for PsA, is still widely prescribed, although it seems to be more effective for reducing skin plaques and joint pain, but doesn’t necessarily reduce joint damage on its own.

Because MTX can be hard on the liver, patients who take this drug are strongly discouraged from consuming alcohol.

Other medications for PsA (and comorbidities) may also be hard on the liver, so if you have questions about the safety of consuming alcohol with your prescription drugs, it’s important to talk with your doctor before making any decisions on your own. 

Abstinence: Some factors to consider 

While some studies suggest that certain alcoholic beverages are healthier for you than others — because they contain less sugar or more resveratrol — recent publications have concluded that the safest level of drinking is none.

Also, as we age, alcohol affects our bodies differently, so there’s more at stake for those of us over 65. Based on what we know so far, some of us may consider abstinence. Therefore, it’s important to think about how to manage social situations where drinking is common, or even encouraged.

A few suggestions from recovery guide and certified coach, Dani Cirignano, include bringing your own nonalcoholic (NA) beverage and allowing yourself some time to adjust to what might feel awkward, especially during your first few NA events.

It can be helpful to let your host know ahead of time that you’re abstaining, even though Cirignano reminds us that we “don’t owe anybody an explanation.” Finally, since mocktails (and even mocktail bars) are popping up more and more, you may have more opportunities to enjoy gathering socially in sober spaces.

A few final recommendations

Ultimately, you have the freedom to decide how much alcohol you’ll choose to consume, if any. Once you know a little more about how your current medications interact with alcohol, you can utilize some of the information in this article to make informed decisions about consumption.

If you’re older, consider moderating your intake based on the challenges an older body faces while processing alcohol. And consider how consumption affects your PsA flares.

If you want to enjoy the occasional glass of red wine or champagne, you may find it doesn’t affect your flares much, if at all, so allow yourself an occasional treat. But ultimately, those of us with PsA should consider minimizing alcohol intake or abstaining from it completely.

While it may be difficult or awkward at first to clink your glass of sparkling water with others who are drinking martinis, think of it as a toast to your health and well-being. I’ll drink to that!