Rheumatoid Arthritis and Caffeine: What to Consider

Whether it’s served up in the form of hot coffee, iced coffee, energy drinks, soda, or even dark chocolate, Americans love their caffeine. We get about 135 milligrams (mg) of it per day on average, according to the Harvard T. H. Chan School of Public Health.

Over 60 percent of Americans drink coffee each day, making it more popular than any other beverage, including water, according to the National Coffee Association. The average daily consumption per coffee drinker is almost three cups.

People with rheumatoid arthritis (RA) often experience fatigue, so they may turn to coffee to give them a boost. Others simply like the taste or are in the habit of drinking it. But is caffeine something people living with rheumatoid arthritis should be consuming?

Some studies have shown that coffee is beneficial for health, but others have not.

A review of various observational studies by Danish scientists found that high coffee consumption was associated with a low risk of mortality, as well as reduced odds of cardiometabolic diseases, some cancers, and gallstones. And Mayo Clinic notes that research suggests coffee may offer a degree of protection against Parkinson’s disease, type 2 diabetes, liver disease, and heart attack and stroke. But coffee can raise blood pressure — and a high intake of boiled, unfiltered coffee has also been linked to an increase in cholesterol levels. Women who are pregnant, trying to become pregnant, or breastfeeding need to watch their caffeine consumption as well.

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When researchers have specifically studied people with RA and the association between heavy coffee consumption and incidences of the condition, the data has been conflicting.

In a review of studies published in Frontiers in Nutrition in 2022, researchers “found that a higher intake of coffee and decaffeinated coffee was associated with increased risk of RA.” One additional cup of coffee per day was associated with an increased risk of 6 percent, and one extra cup of decaf was associated with an increased risk of 11 percent. (The study authors suggest that the higher increase with decaf coffee could have to do with the decaffeination process, which involves chemicals, as well as the drink’s respective antioxidant content.)

A large meta-analysis concluded that people living with seropositive RA (although not seronegative RA) were more likely to drink a lot of coffee, although doctors were quick to say that an association doesn’t prove that one causes the other. Drinking a lot of decaf was not linked to higher RA rates.

Meanwhile, Swedish researchers studying tea consumption, which has caffeine but not at the same levels as coffee, found that heavy use of the beverage was correlated with lower rates of RA.

The bottom line is that coffee may be good in some ways but can be bad in others, such as increasing a person’s heart rate, says Andrew Wang, MD, PhD, a rheumatologist and an associate professor of medicine and immunobiology at Yale School of Medicine in New Haven, Connecticut.

“I tell my patients to drink coffee if they enjoy it, but not to drink it as medicine, and, as always, to listen to their body,” Dr. Wang says.

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Caffeine is not contraindicated for the common medications taken for RA, but it’s worth noting that it may either mitigate or worsen certain side effects of RA meds such as prednisone and methotrexate.

Prednisone Because one side effect of prednisone is insomnia, you might want to ditch the java and other highly caffeinated drinks if you are on the steroid and are having sleep issues.

Methotrexate If you’re taking methotrexate (Rheumatrex, Trexall), however, you may actually want to consider adding a little caffeine to your routine. When researchers followed people with RA on this disease-modifying antirheumatic drug for nearly a year, they found that of the people who had trouble tolerating the drug because of its unpleasant symptoms, more than half were fine when they took some caffeine, in the form of coffee or dark chocolate, along with their medicine. Another 13 percent experienced partial relief by adding caffeine, according to the study.

You’re definitely overconsuming caffeine if you experience insomnia, jitters, a fast heart rate, nausea, a headache, or other unwanted effects, the U.S. Food and Drug Administration (FDA) says. If you decide to cut back, do so gradually to avoid unpleasant withdrawal symptoms such as headaches or anxiety.

According to the FDA, up to four or five cups of coffee, some 400 mg a day of caffeine, is not associated with any dangerous side effects, but it notes that people vary in their sensitivity to caffeine, and that some medications can impact caffeine metabolism.

Experts say that until more research clarifies caffeine’s role, there’s probably no reason to stop drinking what you love. You might want to drink it in moderation — something like a cup or glass or two a day — especially if caffeine makes you hyper or keeps you up at night.

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Coffee and tea contain caffeine, of course. But other beverages do too. The biggest sources of caffeine are coffee (an 8 ounce cup of drip coffee has about 145 mg; brewed has 95 mg) and energy drinks (some have as much as 200 mg; an 8 ounce can of the popular drink Red Bull has about 80 mg). Be aware of your portion size. Many mugs and coffee-shop drinks can hold as much as 20 ounces.

According to Harvard University’s T.H. Chan School of Public Health, other sources of caffeine include a shot of espresso (65 mg), a cup of black tea (47 mg), green tea (28 mg; herbal tea contains no caffeine), 12 ounces of Mountain Dew (55 mg) or cola (40 mg), an ounce of dark chocolate (24 mg; 6 mg for milk chocolate), and decaffeinated coffee (4 mg). Guarana seeds, which are used as an extract in some energy drinks, contain about four times as much caffeine as coffee beans.

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Keep in mind that soft drinks and elaborate coffee drinks with pumps of syrup or whipped cream have more than just caffeine in them.

As the online arthritis community CreakyJoints notes, fancy coffee-shop brews can contain a dozen or more teaspoons of sugar. For example, a grande White Chocolate Mocha with whipped cream from Starbucks has 430 calories and 53 grams of sugar. Dunkin’s Medium Mocha Swirl Frozen Coffee clocks in at 670 calories and 129 grams of sugar. Excessive sweeteners promote inflammation in the body, which over time can damage tissues, including joints, CreakyJoints notes.

High-sugar coffee drinks often contain unhealthy fats too, especially saturated fat, which is also linked to inflammation. The Arthritis Foundation recommends limiting saturated fat when you have arthritis.

Try to avoid the extras and think of a dressed-up drink from a coffee shop as a rare treat. And don’t forget to drink water, which not only hydrates the body but also helps counter the potential diuretic effects of caffeine.

Additional reporting by Deborah Shapiro.