Key points
- Coffee and caffeine aren’t universally or strongly associated with rheumatoid arthritis risk
- High intakes of coffee (i.e. 4 or more cups per day) might be associated with rheumatoid arthritis
- There are likely to be genetic factors at play that could improve or worsen responses to caffeine and coffee
- Coffee might contain chemicals that trigger autoimmune pain (other than caffeine)
- Clinical experience suggests that while coffee is a healthy drink for many people, it can trigger increased arthritic pain in some people with autoimmune conditions
in clinical practice, I have noticed that some of my chronic, and particularly autoimmune-related pain clients, benefit from reducing or avoiding coffee. This may be due to reduced stimulation and resultant pain-triggering from reduced caffeine, or possibly due to other triggers in coffee.
However, the research on caffeine, coffee, and pain overall is equivocal, except for the use of caffeine to help treat certain headaches and migraines. Of particular interest has been the emerging research on coffee and rheumatoid arthritis (RA).
Rheumatoid arthritis is a chronic autoimmune condition affecting up to 1% of all adults. It results in sometimes crippling pain and debility of joints, particularly the small joints of the hands and feet.
Rheumatoid arthritis is a chronic autoimmune condition affecting up to 1% of all adults
Cohort studies have found no overall association between coffee consumption and the risk of RA.1 A review had suggested a link between coffee and RA using some analyses but not others[1],2 and a 2014 review found a significant link between high coffee consumption and risk of RA.3
Interestingly, in an earlier cohort study using data from the Iowa Women’s Health Study, neither caffeine nor caffeinated coffee were a risk factor for RA but drinking 4 or more cups of decaffeinated coffee per day had around 2 ½ greater risk of developing RA,4 and in a 2000 study, a similar risk was found for any coffee intake of four or more cups per day (with RF positive RA).5 However this was not found in a similar cohort (Nurses’ Health Study) in a 2003 study.6
A recent genetic study has demonstrated a link between the CT genotype of ADOARA2A rs2298383, rs3761422 and rs2267076 SNPs and rheumatoid arthritis with higher coffee intakes.7
[1] The inverse-variance weighted method showed a causal association between coffee consumption and RA (beta = 0.770, SE = 0.279, p = 0.006). While the MR-Egger analysis showed no causal association between coffee consumption and RA (beta = 2.744, SE = 1.712, p = 0.355), the weighted median approach demonstrated a causal association between coffee consumption and RA (beta = 0.751, SE = 0.348, p = 0.031)
Summary
It is unclear whether coffee independently increases the risk of developing RA. On balance, data suggest that coffee is not strongly or universally associated with the incidence of RA but there may be some dose-effect and high coffee users may be at greater risk.
It is also unclear whether caffeine, other chemicals in coffee, or a combination of these are at play with RA and symptomology of other autoimmune conditions. There may also be genetic factors at play which predispose some people to greater risk. Additionally, different preparation methods may concentrate different chemicals which may be triggers for autoimmune pain responses.
Clinically we have noticed that some people suffering from autoimmune-related pain, from RA and other RA-like expressions of autoimmune arthritis, experience reduced pain when limiting the coffee intake of all types (decaffeinated and containing caffeine). Further research should evaluate not just the presence of the condition, but symptomology, dose-effects, and types of coffee consumed.
Different preparation methods may concentrate different chemicals which may be triggers for autoimmune pain responses
References
1. Lamichhane D, Collins C, Constantinescu F, Walitt B, Pettinger M, Parks C, et al. Coffee and Tea Consumption in Relation to Risk of Rheumatoid Arthritis in the Women’s Health Initiative Observational Cohort. JCR: Journal of Clinical Rheumatology. 2019;25(3):127-32.
2. Bae S-C, Lee YH. Coffee consumption and the risk of rheumatoid arthritis and systemic lupus erythematosus: a Mendelian randomization study. Clinical Rheumatology. 2018;37(10):2875-9.
3. Lee YH, Bae S-C, Song GG. Coffee or tea consumption and the risk of rheumatoid arthritis: a meta-analysis. Clinical Rheumatology. 2014;33(11):1575-83.
4. Mikuls TR, Cerhan JR, Criswell LA, Merlino L, Mudano AS, Burma M, et al. Coffee, tea, and caffeine consumption and risk of rheumatoid arthritis: Results from the Iowa Women’s Health Study. Arthritis & Rheumatism. 2002;46(1):83-91.
5. Heliövaara M, Aho K, Knekt P, Impivaara O, Reunanen A, Aromaa A. Coffee consumption, rheumatoid factor, and the risk of rheumatoid arthritis. Annals of the Rheumatic Diseases. 2000;59(8):631-5.
6. Karlson EW, Mandl LA, Aweh GN, Grodstein F. Coffee consumption and risk of rheumatoid arthritis. Arthritis & Rheumatism. 2003;48(11):3055-60.
7. Soukup T, Hloch K, Doseděl M, Tebbens JD, Nekvindová J, Šembera Š, et al. The influence of coffee intake and genetics on adenosine pathway in rheumatoid arthritis. Pharmacogenomics. 2020;21(11):735-49.
