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Can Caffeine Trigger Rheumatoid Arthritis Flares?

Medically reviewed by Ariel D. Teitel, M.D., M.B.A.
Written by Alicia Adams
Posted on January 27, 2022

Fatigue is often part of living with rheumatoid arthritis (RA). People — including those without RA — frequently turn to caffeinated drinks like coffee to help alleviate such fatigue. While caffeine may lift your energy levels, is it considered beneficial for your health? Or, for people with RA, could it contribute to your symptoms? Could it be linked to RA flares? Research indicates the answers are mixed — and can vary with each individual.

Rheumatoid arthritis is an autoimmune disease where a person’s immune system mistakenly attacks the lining surrounding their joints, causing damage to the joints, joint tissue, and bones. While this inflammatory disease can manifest with varied symptoms, people living with RA experience flares (or flare-ups) — intense episodes of joint pain, stiffness, and fatigue.

What Is Caffeine?

Caffeine is a central nervous system stimulant and the most consumed stimulant in the world. Caffeine is found in many foods, drinks (especially energy drinks), and supplements. It can be manufactured or found naturally.

The 7 most common flare triggers in rheumatoid arthritis

Some of those natural sources include:

  • Coffee beans (coffee beverages)
  • Cacao beans (chocolate and cocoa drinks)
  • Guarana beans (energy drinks and supplements)
  • Tea leaves (beverages)
  • Kola nuts (cola soft drinks)

The majority of caffeine intake in the United States is from coffee, tea, and soda. In fact, according to the National Coffee Association of U.S.A., more than 62 percent of people drink coffee every day.

The amount of caffeine in a cup or 12-ounce can varies depending on the beverage:

  • Coffee — 95 milligrams
  • Black tea — 47 milligrams
  • Cola soft drinks — Typically about 40 milligrams
  • Decaffeinated coffee —4 milligrams

Is Caffeine a Culprit?

Rheumatologists often recommend lifestyle and diet modifications to help people manage their RA symptoms. Caffeine is usually addressed: Is it considered a trigger for rheumatoid arthritis pain? Will it increase the risk of an RA flare? Research shows the answer is not a neatly packaged yes or no, but is more of a mixed conclusion. Caffeine can be helpful for some people — but not for others.

In 2016, The Iowa Women’s Health Study — an 11-year-long study of more than 30,000 women ages 55 through 69 — concluded that people who drank decaffeinated coffee had an increased risk of developing rheumatoid arthritis. It also revealed that caffeinated tea and coffee consumption pointed to a decreased risk of a person developing RA. Researchers concluded a person’s reaction varied from one individual to the next.

Members of myRAteam report having a variety of reactions to caffeine. “Painful day,” one member wrote. “I am trying to cut down on coffee. Caffeine is a trigger.”

Other members have shared that they look forward to their coffee. “Coffee is good,” a member stated. “I drink one cup, which helps me clear my head and gives me energy to start my day.”

Another member noted that one source of caffeine didn’t have the same effect as a different source for them. “I wonder if my flare-up could be from the caffeine in soda,” they wrote. “When I drink caffeinated soda, it affects me. But I can drink an energy drink and it doesn’t bother me at all.”

Polyphenols sometimes occur in the same natural sources that contain caffeine. (A polyphenol is an organic substance found in plants. They contain antioxidants and can have anti-inflammatory effects.) So while you might choose a beverage for its caffeine, it could have other benefits. In fact, polyphenols are so helpful, the Arthritis Foundation recommends drinking tea for its high level of the substance. Green tea in particular has especially high levels of one “super” polyphenol: epigallocatechin gallate (ECCG). ECCG has been called out for being particularly helpful for RA symptoms. Coffee also contains polyphenols.

How Much Caffeine Is the Right Amount?

According to the U.S. Department of Agriculture’s Dietary Guidelines for Americans, 400 milligrams of caffeine per day — like that contained in about 3 to 5 cups of coffee — is considered a moderate amount and is generally tolerated by most people. However, that guideline doesn’t specifically consider people with RA. The Arthritis Foundation, however, recommends drinking caffeinated coffee in moderation, which it defines as 1 to 2 cups a day.

Plus, how any person processes and reacts to caffeine varies due to genetic factors. Some tolerate amounts toward the higher end of the dietary guidelines, while others experience side effects like jitteriness, insomnia, high blood pressure, and anxiety.

Caffeine and RA Medication

While caffeine generally does not interfere with standard RA medications, you may want to reconsider your intake if you are taking prednisone. A potential side effect of prednisone is insomnia, so if you find yourself struggling to sleep, reducing your caffeine consumption may help.

Caffeine may actually be useful if you don’t tolerate methotrexate (a disease-modifying antirheumatic drug, or DMARD, used to treat RA) well. A study published in 2017 discovered that 68 percent of people who experience moderate to severe intolerance to methotrexate found that taking caffeine with their dose either partially or fully relieved their side effects from the drug.

Talk to your doctor if you’re taking methotrexate and are concerned about side effects.

Cutting Back on Caffeine

If you choose to reduce or cut out caffeine from your diet, do so with your doctor’s knowledge and guidance. They might suggest doing so slowly to minimize withdrawal symptoms, like headaches. Trading a lower-caffeinated beverage for its counterpart might help you taper off. Green, white, and black teas contain caffeine but much less cup-for-cup than coffee. And post in myRAteam to see what other members have tried.

The Bottom Line

Talk to your doctor if you are concerned that caffeine may be affecting your RA symptoms.

Whether caffeine is beneficial or not — and how much you can best tolerate — depends on you as an individual.

Talk With Others Who Understand

On myRAteam, the social network for people with rheumatoid arthritis and their loved ones, more than 191,000 members come together to ask questions, give advice, and share their stories with others who understand life with rheumatoid arthritis.

Are you living with rheumatoid arthritis and wondering if caffeine triggers RA flares? Share your experience in the comments below, or start a conversation by posting on your Activities page.

References
  1. Rheumatoid Arthritis: Living and Dealing With Fatigue — InformedHealth.org
  2. Coffee Consumption Modulates Inflammatory Processes in an Individual Fashion — Molecular Nutrition & Food Research
  3. Rheumatoid Arthritis — Mayo Clinic
  4. Rheumatoid Arthritis (RA) — Centers for Disease Control and Prevention
  5. Understanding Rheumatoid Arthritis Flares — Arthritis Foundation
  6. Lifestyle Modification in Rheumatoid Arthritis: Dietary and Physical Activity Recommendations Based on Evidence — Current Rheumatology Reviews
  7. Coffee, Tea, and Caffeine Consumption and Risk of Rheumatoid Arthritis: Results From the Iowa Women’s Health Study — Arthritis & Rheumatology
  8. Best Drinks for Arthritis — Arthritis Foundation
  9. Caffeine in the Diet: Country-Level Consumption and Guidelines — Nutrients
  10. Caffeine — Harvard T.H. Chan School of Public Health
  11. Get Smart About Caffeine — National Consumers League
  12. NCA Releases Atlas of American Coffee — National Coffee Association USA
  13. Dietary Guidelines for Americans 2020-2025 — United States Department of Agriculture
  14. Interindividual Differences in Caffeine Metabolism and Factors Driving Caffeine Consumption — Pharmacological Reviews
  15. Prednisone — StatPearls
  16. Methotrexate Intolerance in the Treatment of Rheumatoid Arthritis (RA): Effect of Adding Caffeine to the Management Regimen — Clinical Rheumatology
  17. Coffee Consumption and Risk of Rheumatoid Arthritis — Arthritis & Rheumatology
  18. Plant Polyphenols as Dietary Antioxidants in Human Health and Disease — Oxidative Medicine and Cellular Longevity
  19. Potential Benefits of Green Tea Polyphenol EGCG in the Prevention and Treatment of Vascular Inflammation in Rheumatoid Arthritis — Life Sciences
  20. The Role of Polyphenols in Human Health and Food Systems: A Mini-Review — Frontiers in Nutrition
  21. Guarana Provides Additional Stimulation Over Caffeine Alone in the Planarian Model — PLOS One
  22. Caffeine: How To Hack It and How To Quit It — Cleveland Clinic
Posted on January 27, 2022
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Ariel D. Teitel, M.D., M.B.A. is the clinical associate professor of medicine at the NYU Langone Medical Center in New York. Review provided by VeriMed Healthcare Network. Learn more about him here
Alicia Adams is a graduate of Ohio State University and worked at their medical research facilities supporting oncology physicians and investigators. Learn more about her here

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