Caffeine may worsen rheumatoid arthritis

Impact of caffeine on rheumatoid arthritis: Worsening symptoms and risks.
Mahitab Hany, BS Pharm, PGDipClinPharm, PGDipClinNutrition, BCNSP

Overview

As a clinical pharmacist, staying vigilant about drug interactions is essential, especially concerning caffeine and methotrexate efficacy in rheumatoid arthritis (RA). Here’s what you need to know...

NPS recommendations

Methotrexate and its mechanism in RA

Methotrexate helps reduce inflammation in RA by increasing adenosine levels, which promotes anti-inflammatory effects. However, caffeine, an adenosine receptor antagonist, may interfere with this mechanism, potentially reducing methotrexate’s effectiveness.

Current evidence and recommendations

  • Evidence: Research is ongoing to determine how significant caffeine's impact on methotrexate might be. While the exact influence remains under investigation, caution is advised.
  • Recommendation: For patients on methotrexate who aren’t seeing improvement, consider advising them to limit caffeine intake.

Caffeine intake guidelines

  • Suggested limit: Recommend keeping caffeine intake below 120 mg/day (roughly one cup of coffee).
  • Sources of caffeine: Remind patients to account for caffeine in teas, soft drinks, and herbal supplements containing guarana, cola nut, etc. For further information, refer to our comprehensive note, "Overview of Rheumatoid Arthritis".

NPS-adv

References

  1. Nesher G, Mates M, Zevin S. Effect of caffeine consumption on efficacy of methotrexate in rheumatoid arthritis. Arthritis Rheum. 2003 Feb;48(2):571-2.
  2. Cutolo M, Sulli A, Pizzorni C, Seriolo B, Straub RH. Anti-inflammatory mechanisms of methotrexate in rheumatoid arthritis. Ann Rheum Dis. 2001 Aug;60(8):729-35.
Mahitab Hany, BS Pharm, PGDipClinPharm, PGDipClinNutrition, BCNSP