Drinking Alcohol With AS

Reviewed by: HU Medical Review Board | Last reviewed: March 2019 | Last updated: February 2021

Research into alcohol’s impact on ankylosing spondylitis (AS) is thin, but there are plenty of reasons to avoid drinking alcohol if you have AS. One small Chinese study found that alcohol consumption aggravated the overall physical functioning of AS patients.1

Another small study, this one from Finland, reported an increased incidence of alcohol-related deaths from accidents and violence in people with AS. The scientists attributed this to the vulnerability of the AS spine to fractures.2

In both of these studies, most of the participants were male, so there’s even less known about alcohol’s impact on females with AS. Here are some other reasons to avoid drinking alcohol if you have AS.

Medication interactions

The first reason AS patients are discouraged from drinking are the many potentially dangerous interactions alcohol can have with its most commonly prescribed drugs. For instance, alcohol intensifies the effects of some drugs (opiods) while making others less effective, such as DMARDs like methotrexate, leflunomide, and azathioprine.3

Mixing alcohol with over-the-counter pain killers can be especially problematic. Drinking alcohol while taking acetaminophen can cause liver failure, while mixing alcohol and aspirin increases risk of gastric bleeding.4

Liver stress

Processing alcohol adds stress to your liver. Since your liver is already processing all of your medications and foods, excessive, continued drinking may damage your liver, and eventually lead to cirrhosis, or scarring of the liver. Scarring prevents the liver from functioning properly, which makes it difficult for your AS drugs to be effective.5

Gut health

People with AS often also experience inflammatory bowel disease, such as Crohn’s or ulcerative colitis, making their system extra sensitive to the effects of alcohol. The first-line therapy of NSAIDs also irritates many people’s gastrointestinal tract. This makes it harder for your body to absorb or process nutrients as easily and alcohol can amplify this situation.

This is partially because alcohol requires some vitamins to be metabolized, and it interferes with the absorption and storage of some specific vitamins.5

Bone health

Consuming more than two alcoholic drinks per day increases the chance of developing osteoporosis or weakened bones. This is because alcohol interferes with the body’s absorption of calcium and vitamin D. Since people with AS are at higher risk for osteoporosis, avoiding alcohol can protect your bone’s remaining health.6

Weight gain

The empty calories in alcohol make it easy to gain weight if you drink, and extra pounds put additional stress on your body’s already inflamed and stressed joints. That’s why weight management is such an important part of a healthy AS lifestyle.6

Problems of overuse

Yes, drinking alcohol may ease pain, but only at doses that exceed the guidelines for moderate daily use. Ultimately, drinking in large doses makes pain worse. One, doctors know that if you stop drinking after chronic use it tends to actually increase pain sensitivity. Two, excessive drinking over a long period can cause the nerves in your hands and feet to die, which leads to a painful condition called peripheral neuropathy.4

If you have AS and your drinking slips into the realm of chronic overuse or full-blown alcoholism, there are additional dangers. Namely, long-term excessive drinking causes inflammation throughout the body, which compounds the inflammation already experienced by someone with AS.7

Other habits

Doctors know that smoking worsens AS symptoms and speeds progression of the disease, and smokers often drink adult beverages too.

So, can I drink alcohol with ankylosing spondylitis?

If you want to enjoy the occasional mixed drink, glass of wine or a beer, be safe by talking to your doctor or pharmacist about medication interactions beforehand.

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