Rheumatoid Arthritis and Caffeine: What to Consider
Updated on May 21, 2025
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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.
Two-thirds of Americans drink coffee each day and the average daily consumption per coffee drinker is almost three cups.
People with rheumatoid arthritis (RA) often experience fatigue and may turn to coffee for a boost. The caffeine in coffee can raise your energy levels, lift your mood, and make you more alert. But is caffeine something people living with rheumatoid arthritis should be consuming?
Does Coffee Raise the Risk of Developing Rheumatoid Arthritis?
The evidence is conflicting. Some research suggests a correlation between coffee consumption and RA; in a review of studies, 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 drinks’ respective antioxidant content.)
But contrasting evidence exists, with other studies finding no association between coffee consumption and RA, and some indicating that coffee may protect against RA. It’s important to note that unsweetened coffee has been associated with a reduced risk of RA, and this protective effect may have to do with enhanced metabolism and anti-inflammatory responses.
Pros and Cons of Caffeine When You Have RA
Pros
Caffeine intake can improve:
- Mood
- Energy levels
- Alertness and ability to concentrate
Cons
- Coffee (and caffeine intake) can temporarily raise blood pressure.
- Some studies have shown that drinking five or more cups of coffee a day lowers bone density among some groups of women. This is important for people with RA, who are at greater-than-average risk for osteoporosis.
- Caffeine intake can lead to sleep disruption. Sleeping well is essential for good health, and poor sleep can worsen RA symptoms.
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.
Caffeine and Rheumatoid Arthritis Medication
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, methotrexate, and nonsteroidal anti-inflammatory drugs (NSAIDs).
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.
NSAIDs Caffeine has been found to enhance the analgesic (pain-relieving) response to NSAIDs, leading to combination formulations, often aimed at headaches. But NSAIDs, which are commonly used for RA pain relief, as well as caffeine, can cause stomach upset in some people. Consuming both together could compound the irritation, which is something to be aware of, if you’re sensitive to GI side effects.
How Much Caffeine Is Too Much?
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, some 400 mg a day of caffeine (two to three 12-ounce cups of coffee), is not associated with any dangerous side effects in most adults, 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.
Which Foods and Drinks Contain Caffeine?
Coffee and tea contain caffeine, of course. But other beverages do, too. The biggest sources of caffeine are:
- Energy drinks: Some have as much as 200 mg; an 8-ounce can of the popular drink Red Bull has about 80 mg. Guarana seeds, which are used as an extract in some energy drinks, contain about four times as much caffeine as coffee beans.
- Coffee: An 8-ounce cup of drip coffee has about 145 mg; brewed has 95 mg.
- Espresso: One shot has 65 mg.
- Black tea: One cup has 47 mg.
- Soda: A 12-ounce can of Mountain Dew has 55 mg and cola has 40 mg.
- Green tea: One cup has 28 mg (herbal tea contains no caffeine)
- Dark chocolate: An ounce has 24 mg.
- Milk chocolate: An ounce has 6 mg.
- Decaffeinated coffee: One cup has 4 mg.
Be aware of your portion size. Many mugs and coffee-shop drinks can hold as much as 20 ounces.
Watch Out for Those High-Calorie Coffee Concoctions
Keep in mind that soft drinks and elaborate coffees with pumps of syrup or whipped cream have more than just caffeine in them.
Excessive sweeteners promote inflammation in the body, which over time can damage tissues, including joints.
High-sugar coffee drinks often contain unhealthy fats, too, especially saturated fat, which is also linked to inflammation. People with RA should limit their intake of saturated fat.
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.
The Takeaway
- The evidence on whether consuming caffeine or coffee is linked to the development of RA is conflicting. Some studies have found a beneficial, protective effect, while others have found an increased risk for RA.
- While caffeine can boost your energy, mood, and focus, too much of it can also raise your blood pressure, make you jittery, and lead to sleep problems.
- If you take prednisone, methotrexate, or NSAIDs for RA, be aware that caffeine intake may either worsen or counter the side effects of these drugs.
- In general, moderate consumption of coffee and caffeine is fine if you have RA, but limit sugary energy drinks and coffee drinks loaded with syrups and full-fat dairy.
Additional reporting by Deborah Shapiro.
Meet Our Experts
Samir Dalvi, MD
Medical Reviewer
Samir Dalvi, MD, is a board-certified rheumatologist. He has over 14 years of experience in caring for patients with rheumatologic diseases, including osteoarthritis, rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, lupus, and gout.
Meryl Davids Landau
Author
Meryl Davids Landau is an award-winning health and science writer and a women's fiction author. Her latest novel is Warrior Won, in which a woman facing serious life challenges must learn to use all of her mindfulness and meditation skills. Meryl's articles have appeared in numerous publications, including National Geographic, the Washington Post, The New York Times, Prevention, Oprah Magazine, Consumer Reports, AARP, and of course many pieces for Everyday Health.
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Resources
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