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Methotrexate and Alcohol — SCE Rheumatology MCQ

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EasyRheumatology PharmacologyMethotrexate and AlcoholSCE Rheumatology

A 50-year-old woman with RA asks about alcohol consumption while on Methotrexate. According to BSR 2025 guidelines what is the current recommendation?

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Correct answer: C — Moderate alcohol intake within national guidance limits (no more than 14 units per week) is acceptable with enhanced liver monitoring if additional risk factors are present

BSR 2025 csDMARD guidelines no longer mandate complete alcohol abstinence on Methotrexate. Moderate alcohol consumption within UK national guidelines (no more than 14 units per week spread over several days) is considered acceptable. However patients with additional liver disease risk factors (obesity diabetes hepatitis) should receive enhanced monitoring (FIB-4 scoring elastography) and may be advised to reduce or avoid alcohol entirely. The relaxation of absolute abstinence reflects recognition that moderate intake does not significantly increase hepatotoxicity risk in low-risk patients.

Reference: BSR 2025 - Guideline for prescription and monitoring of conventional synthetic DMARDs