我们大多数人开始用甲氨蝶呤治疗类风湿关节炎。当你的风湿病医生给你开处方的时候，他们通常会说“服药时不要喝酒是非常重要的。”我们在RAHealthCentral上有很多关于甲氨蝶呤和酒精的问题。为什么服药时不能喝酒？这是不是意味着你在婚礼上连一杯香槟都不能喝？还有其他不应该喝酒的药物吗？随着假期的临近，我们开始为您解答这些问题。我和Dr. Yusuf Yaziciof theNYU Langone Medical Center关于RA药物和酒精。
为什么甲氨蝶呤和酒精不混合
“甲氨蝶呤是通过肝脏,”博士Yazici explained. That means that the liver is the organ that processes or metabolizes the medication. One of the possible side effects when taking methotrexate is liver damage. "It can be caught very early in blood tests," Dr. Yazici said. This is why you pop in to see the vampires at the lab every six weeks to get blood drawn for a肝板. 定期的血液检查有助于你的医生密切关注你的肝功能，并在问题严重之前发现潜在的问题。如果测试显示肝酶升高的迹象，你停止服用甲氨蝶呤，你的肝脏逐渐恢复正常。
在甲氨蝶呤开始用于类风湿关节炎之前，皮肤科医生就用它来治疗银屑病。Yazici博士解释说，历史上，当甲氨蝶呤用于银屑病时，建议患者完全避免饮酒。然而，在风湿病方面的研究表明，它对类风湿关节炎患者的肝脏的影响不如银屑病患者。银屑病的肝脏检查阳性的病例比类风湿关节炎的要多得多。”因此，风湿病不再遵循旧的建议完全戒掉。尽管如此，仍有潜在的损害，因此Yazici博士说，这些天，风湿病学家“仍然告诉患者观看，只在非常偶然的特殊事件和最多一两杯的情况下饮用。”
I asked Dr. Yazici about the possible consequences of drinking while on methotrexate. He explained that in "psoriasis patients, you can get肝硬化他接着说，“如果你受到损伤，肝脏可以自我修复，但有一个门槛过去了，它无法自我修复。对类风湿性关节炎患者来说，这是一个最坏的情况——定期的血液检测能够在他们变得严重之前发现潜在的问题。停药会让你的肝脏自行痊愈。然而，Yazici博士的声明提醒你，在非常认真地服用甲氨蝶呤的同时，要采纳医生关于饮酒的建议。
其他药物和酒精
Methotrexate is not the only medication used to treat RA that is processed through the liver. Dr. Yazici explained that "rheumatologists use NSAIDs, methotrexate, leflunomide (Arava). These are all cleared through the liver and if something happens, they can cause damage to the liver in some patients." If you are on Arava for your RA, you will also have regular blood tests to check your liver function.
I asked Dr. Yazici if we should assume that the recommendation to only drink alcohol very occasionally applies to all medications that require regular liver function tests. He replied that it "is the safest way, it's what I recommend to my patients." In addition to methotrexate and Arava,Xeljanz, a new medication to treat RA, may also cause elevated liver enzymes. It's likely that the caution against alcohol consumption will also affect people who will take this drug. Dr. Yazici explained that the recommendation against drinking alcohol does not apply quite as much to the Biologics (Enbrel, Humira, Orencia, etc.), but that you should still be careful.
Yazici博士还解释说，用于治疗类风湿关节炎的其他药物也可以通过肝脏清除，即非甾体抗炎药（非甾体抗炎药，如萘普生、伏尔坦、西乐葆等）。因此，如果你确实服用非甾体抗炎药来解决你的炎症症状，你也应该非常小心酒精。
And there's more. Dr. Yazici mentioned that "as patients age, they start taking other medications that also affect the liver. This means the potential for problems is higher." He also gave another example. "Patients may only be on methotrexate, but have an infection and get antibiotics. They get a cold and take cold medicine. Suddenly, they're on three medications that affect the liver. They're not thinking of the other ones as liver toxic and then they also drink." This is a valuable reminder to always be aware of the possible side effects and interactions of medication, both prescription and over-the-counter. Speak to your doctor or pharmacist to clarify whether you should be careful with particular medications.
What This Means for You
根据Yazici博士的说法，在服用甲氨蝶呤和其他经肝脏加工的药物时饮酒的建议有些放松。风湿病学家现在可能会告诉你，喝一两杯是可以的，特别是在特殊场合。这并不意味着每周五晚上下班后-虽然对我们很多人来说这是一个非常特别的活动-但在新年或婚礼上喝一杯香槟是可以的。但是，你应该知道这是一个非常普遍的建议，你的个案可能会有所不同。如果你已经经历过由于药物、疾病或上瘾导致的肝损伤，你的医生可能会告诉你要完全戒掉。正如Yazici博士提到的，有一个临界点，你的肝脏可能无法再次自我愈合。
不管你过去的病史如何，重要的是你要和你的风湿病医生，家庭医生和药剂师谈谈你服用的药物，包括处方药和非处方药。确保你知道可能与其他药物的相互作用，以及副作用和注意事项。不要害怕坦白过去的药物滥用史你的医生越了解你，他们就越能治疗你。如果你过去没有酗酒或其他上瘾物质的问题，你还是应该对你的医生坦白你是如何喝酒的。如果你每天晚餐时喝一杯酒，你的医生很可能会告诉你停下来，找其他放松的方法。总的来说，控制好你的RA对你的身体和情绪健康都比一杯葡萄酒好。