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Patients who take methotrexate traditionally have been told to avoid alcohol because it might heighten risk for hepatotoxicity (i.e., beyond that associated with methotrexate itself). However, evidence to support this advice for patients with rheumatoid arthritis (RA) is limited. Researchers examined data on 11,839 RA patients in primary care practices in the U.K. who started methotrexate between 1987 and 2016. Alcohol intake was measured in “units,” defined as 8 g of alcohol per unit (in the U.S., a “standard drink” contains 14 g of alcohol, or nearly 2 units). Hepatotoxicity was defined as tranaminitis (i.e., elevation in alanine aminotransferase or aspartate aminotransferase ≥3 times the upper limit of normal [ULN]).
During 47,090 person-…