Alcohol is a risk factor for developing PsA. Fortunately, it is a lifestyle factor that can be changed. Alcohol can affect the immune system in several ways. When a person drinks alcohol regularly, it is theorized that their immune system is more ‘ramped up’, or what we call ‘pro-inflammatory’.1 However, this ‘ramped up’ version of the immune system isn’t better or stronger – in fact, it can make people more susceptible to infections.
Alcohol can also inappropriately stimulate immune cells known as B- and T-lymphocytes, leading to production of antibodies to a person’s own body cells.2 These antibodies may start attacking tissues in the body, leading to inflammation and tissue damage. Alcohol also increases the levels of an enzyme that makes tumour necrosis factor (TNF), a molecule that is very pro-inflammatory and is plays an important role in psoriasis and psoriatic arthritis (PsA).3 Skin cells called keratinocytes are also stimulated to grow much more quickly in the presence of alcohol; this overgrowth of keratinocytes is one of the many mechanisms of developing psoriasis, and possibly PsA. Finally, because alcohol has a lot of calories, drinking alcohol regularly can contribute to increasing weight and/or metabolic syndrome – both of which can worsen psoriasis and PsA.
Drinking alcohol is a well-known risk factor for developing psoriasis.4 In PsA, however, research is still ongoing. A 2020 study showed that patients with psoriasis who are moderate drinkers (which this study described as 0.1-3 units of alcohol* per day or 3 beers/day maximum) had an increased risk of developing PsA compared to non-drinkers.5 Another study from 2015 looked at PsA in women and showed that excessive alcohol drinking (>30 grams of alcohol* per day or approximately 2 or more beers/day) can trigger PsA when compared to non-drinkers.6 The same study showed that moderate drinking (which this study described as 0.1-14.9 grams per day, or roughly 1 beer/day) had the lowest risk of triggering PsA.
Even if you do not drink moderately or more often than that, drinking alcohol can increase your risks of developing psoriasis or PsA. Further research is needed to further clarify the association between alcohol and PsA. Though it is not entirely clear what dose of alcohol increases the risk of developing PsA, patients with psoriasis who drink alcohol may find benefit from reducing their consumption of alcohol.
Medications that may be used to treat psoriasis or PsA also affect the liver, so these medications may be contraindicated in patients with heavy alcohol use. Reducing your alcohol consumption can improve inflammation, reduce liver damage, and allow the use of more medications to control the disease.
*one unit of alcohol = ~14 grams of alcohol = one 12 oz beer = a 5 oz glass of wine = a 1.5 oz shot of hard liquor7
Written by: Elena Pastukhova, H.BSc, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
Reviewed by: Dr. Anastasiya Muntyanu, MD, Dermatology Resident, Department of Dermatology, University of Toronto, Toronto, ON, Canada
Medically Reviewed by: Dr. Vinrod Chandran, December 2022