Is the controversial role of alcohol in arthritis still a Hamletic dilemma?

While alcohol consumption is widely considered detrimental in rheumatic diseases, literature suggests its effects might vary depending on dose, beverage type and specific disease context. This narrative review examines current evidence studying the relationship between alcohol intake and disease activity in inflammatory arthropathies, such as rheumatoid arthritis (RA), gout and spondyloarthritis (SpA). Specifically, we aim to evaluate the potential beneficial or harmful effects of alcohol on different inflammatory joint diseases, accounting for variations in beverage type and consumption volume. As a secondary objective, we investigate the impact of alcohol on intestinal homeostasis within these rheumatic conditions. Observational studies in RA suggest that low-to-moderate alcohol consumption may be associated with a reduced risk of disease onset and lower disease activity; however, causality remains uncertain due to confounding factors. Conversely, alcohol intake in gout and SpA consistently shows dosedependent detrimental effects that accelerate disease progression. Nevertheless, pivotal studies indicate that certain non-ethanol compounds found in red wine, such as polyphenols and resveratrol (RS), can reduce inflammation. While chronic alcohol consumption disrupts intestinal homeostasis by promoting gut dysbiosis and compromising barrier integrity, potentially fuelling systemic inflammation, RS may exert microbiota-modulating and antiinflammatory effects in experimental models. Overall, current evidence does not support alcohol consumption as a therapeutic strategy in rheumatic diseases. Its effects must be interpreted with caution, balancing disease-specific risks against dose-dependent biological responses.