Dear All,
I am trying to find out whether it is safe to drink an ordinary cup of green tea a day whilst on Methotrexate tablets. Obviously not on day of MTX. Does anyone drink green tea regularly? Or can it interact with MTX?
Apparently it is ok to drink with Enbrel weekly injections. Grateful for replies when convenient please.
Thanks all
I mostly drink green tea, probably 4 or 5 mugs a day. I'm on MTX and have been for 4 years. Nobody has ever mentioned an issue to me.
Brilliant! Thank you very much! Are you on a biologic too with mtx? Please may I ask if you have Rheumatoid Arthritis? Thanks
Am on secukinumab as well, my diagnosis varies between psoriatic and spindly arthritis.
Thank you, all the very best to you.
Ditto, and taken MTX for about 45 years!
Super! Thanks
i too mainly drink Green Tea as well as Red Bush if I fancy something a bit stronger. No one has ever mentioned about any interactions.
Thank you. When I read the MTX leaflet, it did state no black tea, but most tea is black tea? It is really hard to make a decision when on MTX!
Oh I didn’t realise that, I’m not on MTX so can’t really advise , but surely green tea will be ok? May be worth checking with your helpline if you have one? But can see you’ve had a reply from someone on MTX 😊 Enjoy your tea!
Thank you, there have been many reassuring replies from forum.
Which MTX leaflet?
I’ve been on MTX and a biologic for years and was told not to drink more than a normal amount of caffeine (whatever that is), but didn’t mention source of caffeine.
I believe the black tea warning was on the Pfizer MTX tablets, leaflet. But my daughter is now on the Orion brand. But Orion will not comment they only ask for interactions to be reported for their data. Thanks
Rheumy nurse today told me to avoid black tea. Stupidly, I didn't think to ask why - I just said I drank it with milk.
Also, when I said I was trying to drink more water she said best to have it with a slice of lemon or orange. Apparently that prevents it just draining straight through your system. I'd never thought of that.
Good tips, thanks
‘Black tea’ is different to ‘tea without milk’. It’s a type of tea like green, red bush or whatever.
Thank you
Thanks, reassuring!
i dont see why it would be a issue in the first place ?
Me too, by what everyone is saying. Thanks
I think the issue is with caffeinated drink, that you should limit the amount you drink. Some studies show it affects the mtx absorbed, but there are recent studies that show it doesn’t.
Thank you, noted!
I drink green tea everyday along with a couple of coffees and I am on 15mg of MTX. And also trialling ABACEPT after 9 yrs on Tocilizamub which worked well, until it didn't. 🤪 I was diagnosed with RA 24yrs ago and have never heard at all that I can't drink anything even the odd glass of wine. Everything in moderation I think can't hurt 🤞
Agreed. Thank you
Hi, I was told not to have any Caffeine on mtx at all, I have given up anything with Caffeine in including chocolate, it just makes we fill very unwell and sick. I'm on 20mg injections weekly. I have been drinking redbush and decaff tea now for years.
Thanks for good tips.
I’m on methotrexate (3 years) and adalimumab (3 months) and have drunk green tea for donkeys years, at least 5 cups a day. Rheumatology have never asked me about it.
So good to hear this, thanks.
I was on MTX (20mg tablets) for about 18 months. Neither Rheumatology or my GP ever mentioned teas or caffeine being a problem whilst on MTX. I've had a look at the MTX leaflet on the versus arthritis and NRAS websites, no mention of tea or caffine. The only beverage mentioned is alcohol, unsurprisngly. I find it very strange that some people should be told (by health professionals?) that caffeine is a problem, and others aren't. These sorts of uncertainties and inconsistencies just shouldn't arise.
Thank you, I agree.
I wasn’t aware of any advice against tea or coffee drinking. I have been on the max dose, 25mg injections, of methotrexate for 25 years. I drink several cups of black (English breakfast type) tea with milk everyday and a cup of coffee every day with no ill effects.
I recently visited a tea plantation and processing works in Sri Lanka. Green and black Ceylon tea are from the same leaves just dried and left to mature for different lengths of time. All a matter of personal taste, they produced 7 varieties/ grades from the same bushes, going through the colours, green golden brown black. The tea companies in the Uk then mix the different grades to produce their own taste and brand. Breakfast tea probably has more of the blacker leaves. Green tea wouldn’t have any.
25 years ago you were told not to drink any alcohol whilst taking methotrexate. Today providing my blood tests are ok I am told it is ok the drink alcohol in moderation.
If concerned about tea speak to your Dr about it. I tend to follow advice where food and drink is concerned, by being moderate and aware of what my body is telling me.
Thank you so much, great reply! I am born in Colombo, came here 64 years ago when I was 2. I have been back a couple of times on hols. You know much more than me about Ceylon Tea, many thanks! For me I wish there was a tasty breakfast tea which can be consumed in the evenings. But most teas keep me awake! Any tips from you would be super! Many thanks again.
Nope, no one has ever mentioned not eating or drinking anything to me, I'm on 17.5mg MTX. Even alcohol was only mentioned when I asked and was just told to try to keep within recommended limits 😀
Thank you, very reassuring!
Very helpful, thank you
I've just searched on methotrexate with tea, coffee and caffeine and I think it's safe to say there are as many theories as there are research papers.
Overall it looks like the main idea is that a large amount of caffeine may stop methotrexate from working at its best, so if you don't knock back half a dozen double espressos a day you're fine. I reckon one cup of tea shouldn't be a problem.
My rheumy has never mentioned tea, just to add to the straw poll of posters' experiences.
Thanks so much, all noted.
Hi just to clarify, I posted that green tea was caffeine free, I'm sorry, green tea has caffeine in it. Xx
Thank you, maybe some green teas are caffeine free??
I’ve been drinking Green Tea for some years - a perfectly innocuous drink. I can’t think that it would re-act with Methotrexate. I have been taking methotrexate since 1998 - firstly in tablet form and since 2015 by injection.
I’ve never reacted to any drink or food while taking the drug - but, of course, we are all different and our different systems react differently. But this medication is one of the most trusted and well-tried so surely it would have been noted by now if there were anything to avoid in the way of food or drink. Other medications may clash with it, but that would be well documented.
So continue to enjoy your Green Tea!
Thank you. My daughter has been on MTX 15mg weekly tablets with Enbrel since the Covid lockdown. Previously she has been on Enbrel since 2010, but Enbrel was not working as well after 8 years. Now with the MTX it is working. But for the last year she has been suffering from what looks like eczema, she has a large patch on her shin/leg. Our local dermatology department has given her an appointment for September 2025. She's so upset that she has no treatment for it. I am wondering whether she should ask her Rheumatologist to see her about the very large patch on her shin? It could be because of MTX?
Hello MJSlide1958
I’m sorry to learn about your daughter’s eczema - that’ a very nasty condition. I must say I’ve had no trouble with eczema since starting methotrexate, but in 2000 after a mild “flare” of the rheumatoid, my rheumatologist decided to try me on a biologic drug. It was a ”bio-similar” of infliximab - called remsima. Well, after several months I developed eczema - just about everywhere on my body. Nobody connected it with the new drug so I continued with it (all the time taking methotrexate as well).
To cut this story and get to the point! - I stopped the remsima, and gradually all the eczema disappeared. I have never tried another “biologic” or any other of the newer drugs, and whatever caused the flare has not given me any more trouble. I still go on with the methotrexate injections once a week.
The fact that your daughter has to wait so long to see a dermatologist makes me think they don’t connect it with the Enbrel. So if I were your daughter, I would see someone in the rheumatology department in order to get advice. As for treatment! I tried just about everything without much luck - the usual suggestion is E 45 or something similar. Also, it may well be that stress is playing a part in the outbreak.
I would put my money on the Enbrel being the cause even after 8 years. The main problem is that the doctor is trying to get your daughter on something effective for the rheumatoid disease, and these hiccups are part of trial and error. It is unusual to start on a drug like Enbrel before trying methotrexate. But the doctor must have had his reasons.
Patience is the name of this game!
I do wish your daughter the best of luck. It is a wretched disease.
Hi Bienassis,
Thanks so much. Yes, I will let my daughter know to see her Rheumy. Next app in May unfortunately. Strange she has been on Enbrel since 2010 and this is first time the eczema on her leg/shin. Thanks very much
I should have mentioned that I consulted my GP about the eczema and he agreed that the drug I was taking - Remsima - could cause eczema. , especially on the legs. He gave me the name of that particular type of eczema but I’m afraid I’ve forgotten. Should I find it somewhere in my records, I’ll let you know.
Dear Bienassis, Thank you so much, you have been very helpful. You all have! She has been on Enbrel since 2010 without any major problems to note, until now, 14 years later! I wonder if it could be Enbrel starting up now? Many thanks for staying in touch!
Hello MJSlide1958
Just a quick note about your daughter’s eczema. I mentioned the eczema on my legs caused by Remsima - a biologic drug. Well, I have looked up my records and the eczema was “discoid eczema”. This type of eczema can be the result of taking certain biologic drugs. It may not be the case with Enbrel - but worth mentioning to the doctor. Not all biologics have the same side effects, but my doctor confirmed that Remsima can cause an outbreak of discoid eczema on legs.
In any case, I hope your daughter gets over the outbreak as soon as possible - this type of eczema is often restricted to the legs.
Thank you so very much! You have been ever so helpful. I will note for my daughter to ask her Rheumy. How did you manage to treat the eczema whilst it was there? Did you have a prescribed cream to help after coming off of Remsima?
Good morning,
I don’t recall having any particular cream for the discoid eczema on my legs - but I did get some Sudocreme from the chemist, which is very good for healing any stubborn sore spots (it was recommended by a young mother I met while in the chemist shop; she said it was wonderful for nappy rash!) You could ask at the chemist for suggestions; there are many suitable creams and ointments.
Sometimes your doctor might prescribe a cream containing a small amount of a steroid and that would certainly be effective for a while. But on the whole they prefer the use of any general skin moisturiser - like E 45 which comes in various forms - thick cream and lotions - and there is also a liquid form for adding to the bath water. But it does make an oily mess in the bath! Eczema is very stubborn and there’s no cure for most eczemas. It usually clears up on its own. If the cause is a particular drug being used for something else then stopping the drug would obviously help. The discoid on my legs cleared up pretty quickly after stopping the Remsima, but the other eczema I had around my eyes, on my arms and hands just disappeared gradually over several months. It was considered to be caused by the stress I was under at the time. I had just spent 6 weeks in hospital after a very bad fall.
I should think your daughter’s trouble with eczema (if not caused by Enbrel) would clear up eventually - the stubborn eczema is the type inherited. My husband has a mild skin condition - considered to be a “sort of eczema” which is fairly widespread in his family. He’s had it all his life.
Talk to the chemist first - he might advise seeing the doctor; I don’t think steroid creams are sold over the counter; but I may be wrong.
Im sorry this all sounds a bit vague. But skin conditions are so difficult to get rid of quickly. Good Luck!
Dear Bienassis,
Thank you so very much! I don't know about vague, you are certainly not vague! You have explained to me everything possible. This has helped so very much, you do not realise how much you have helped. Explained so well too! All I need to do now is send you a Whatsapp of the good picture I have of her shin part of leg and that can show you completely. It sounds like you have diagnosed well. All she needs to do now is have it confirmed by Rheumy or Dermo. Many thanks again😊👍😘
Dear Bienassis and All,
My daughter's diagnosis came by letter today from the Photo Clinic. The diagnosis stated she has a Solitary Plaque Fitzpatrick Skin Type 4 measuring 4.5cm x 2cm on her Shin/leg. They have given her an appointment for 8th September 2025, which will probably be moved to later. So worried because they have not advised any treatment to manage it, nothing whatsoever! With no explanation, knowing the forms she filled in did state she is on Enbrel and Methotrexate. It she may have to go to her GP for a cream or?? I will ask her to let her Rheumatologist know, but fear he may direct her back to GP, and in the meantime she will stress. And she has to go to work full time. I would have thought that they would have at least recommended an everyday emollient type cream without steroid, for long term use for management at least. Have you or anyone experienced this sort of skin problem, please?
Hello MJSlide1958
I’m pleased you now have a diagnosis for the skin problem.
This is a new one for me, so I’m afraid I can’t be very helpful. But the rheumatologist does need to know, and you should be advised if you can use the usual emollient cream on the plaque. That sort of cream would be prescribed by the GP I imagine. You could Google it and get an idea of the possible treatments.
Skin problems are so varied, and treatments can be hit or miss. From your description this is a single plaque. I did once have a single skin plaque on my upper arm, but it eventually disappeared without any treatment. It was not diagnosed as anything in particular once a biopsy revealed that it wasn’t a form of cancer.
I can understand that this is causing stress; it’s a miserable problem.
I do wish your daughter well - and hope she will get some satisfaction from whatever doctor she can see.
Hi Bienassis,
Thank you so much for your message. So helpful once again and reassuring. My daughter is very stressed at moment with all her health issues. She will of course let her Rheumy know the outcome. I at the moment bought her over the counter ZeroDerma Zerobase emollient cream. It did cost a little over £10 and hoping it will help until GP or Rheumy can advise. GP dragging their feet, it seems! A request has been put in. Just have to wait and see? Otherwise I may book a private appointment with a Dermatologist, just to get it managed, anything to relieve stress. She is very young and would like to also wear nice clothing when Spring/Summer comes. Just hope that my support is helping really? Many many thanks to you
I do sympathise with your daughter and know how difficult it is for the very young to have to cope with seemingly intractable problems. To be diagnosed with rheumatoid disease at a young age is very dispiriting, and when skin problems are added it is truly miserable.
I was diagnosed at the age of 32 and shall be 90 in a few months time. 1967 was not a good time for treatment - nothing like today. But I would like to tell her not to be discouraged - her skin problem will improve and with treatment for the RD she has an excellent chance of years without major problems. I have been very lucky to have had many years of remission - just on methotrexate. My one worry has been that my daughter may contract the disease. But so far that has not happened. She is now 65 and quite fit - although the disease is a family scourge I’m afraid.
The disease Is much more “high profile” these days, and the NRAS has been responsible for a lot of that new thinking.
You are just the support your daughter needs; so keep up the good work!
Dear Bienassis,
I must first congratulate you to your 90th year, so super and hope for everyone. Such a long time to cope with RA, you've done remarkably, especially remission. Did you start on MTX first? Did you have your daughter before RA? How have you coped with MTX for so many years, and was it a high dose weekly? Do you prefer the tablets or injection? So very interesting to know! When did you start on another med along side MTX? It is remarkable to know that you can actually go far with meds. We all hear terrible disadvantage stories about meds, but without meds and management you can't do anything. My daughter had finished her A levels a year after RA started and went on to do her Degree with Enbrel and has been working straight after Graduation and continues. But Ovary problem kicked in at the end of Degree and kicked in again 3 years after Op, Had another Op this year. It has kicked in again. And now the skin problem added. With her Dad advanced cancer. Just hoping it all gets sorted. I am trying my best to stay positive. And I will admit that without NRAS I and my daughter could not have survived it! That's the honest truth, so much praise to all of you with NRAS. 👍😘
Sorry, second Op was May 2024! Another one to come .....
Good Morning,
I’m glad you find the Forum such a help - it’s good to be in contact with other sufferers and know you are not alone. That was not the case in 1967 - there was nothing like the NRAS then. I did meet others at the clinic though, and became very friendly with one of the patients.
To answer your questions: No, I didn’t start on MTX; that wasn’t available at the time. At least, if the drug existed then for rheumatoid disease, I wasn’t prescribed it. In fact, like many other drugs, MTX was developed for quite a different disease - cancer! It was used at the time for treating breast cancer; and it was discovered that it helped those who also had rheumatoid disease. This is not such an uncommon occurrence, and is well known in medical science.
I started on “gold” injections after diagnosis in 1967. Gold was known to reduce inflammation! It seemed to work for a time, but soon afterwards the excruciating pain returned in my right knee (where it all started). I had an operation on that knee - a synovectomy - fairly common at the time but not very successful as the synovial lining of the joint grew back again. But, I was very lucky as it worked very well after a long ”bed rest”. I was a patient at UCH, London, and my Rheumy was very keen on bed rest and I was an in-patient for three weeks at that hospital.
This leads me to the next question: the first symptoms appeared three months after Isabel was born in 1960. The GP prescribed an elastic bandage - with the advice to stop washing floors on my knees; the problem was a simple case of housewife’s knee! What can I say? This now seems incredible. Nevertheless, the knee problem blew hot and cold for the next 7 years but wasn’t very troublesome. Finally, in 1967 I had a very serious flare-up - in the same knee, but also in my hands and feet. Then, blood tests discovered the true cause - rheumatoid disease. There followed treatment with various anti-inflammatory drugs, including large doses of aspirin as well as the “gold” injections.
After discharge from UCH, I had a long remission and had a series of anti-inflammatory drugs. By 1988 I was taking my first DMARD - Azathioprine (this drug was developed to prevent rejection of transplanted organs). It worked like a charm but 10 years later I developed a small skin cancer which prompted my rheumatologist to change the drug to Methotrexate. That was in 1998. No trouble with the change of drug. I continued to be very well.
So that brings me to 2020 when Remsima was added to the MTX after a flare. The flare happened after 6 weeks in hospital ( a bad fall fractured my right hip and elbow, and caused a rib to pierce my right lung). As I have mentioned before, I no longer take the Remsima - but continue on the MTX. Only taking paracetamols for pain.
I do think I’ve been one of the lucky ones. It took 7 years to diagnose - that wouldn’t happen today as quick diagnosis and early treatment is considered essential.
I hope you can make sense of the above as it covers such a long time. It does illustrate how varied responses are to the different medications, but also how luck plays its part. One patient I met in the late 1960s was taking the prescribed “gold” and quite convinced that it had cured her. True, she never had anymore trouble with the disease as far as I know, but nothing cures it. Long remissions are not cures. Your daughter has really had a miserable time in her short life. My heart goes out to her. But I do hope she finds relief from the skin disease and the Enbrel continues its good work.
Your husband is also going through a wretched time with cancer - it is amazing that you can keep positive. I do admire your fortitude; some people seem gifted with such a positive outlook.
Do take care, it is important that you keep as well as possible, but don’t forget you also need support. Do you have friends to chat to? It’s not good to be isolated.
Much love to you both,
Bienassis
Dear Bienassis,
Thank you very much for your reply, which is so helpful and I do understand everything you mention in your reply. It is so interesting to know how others got on before MTX and biologics. It's good you had your baby before the meds came along! And I feel so positive to read you have got on quite well with RA and managed well. I hope the skin cancer has completely gone? It is very hard to worry about these illnesses. I do talk to friends sometimes, but try to contain the subject not to depress others too. I pray alot which helps me alot. I will try to seek counselling, I think it will help. I am not with my X anymore but I pray for him to get through the cancer. I do worry about him too. I will keep you informed re my daughter's skin issue and hope she gets at least prescribed an everyday emollient to manage. The ovarian condition is her main worry because she would like a baby one day. RA for her is part of her life now and has to be managed well in order for her to work full time.
Thank you so very kindly for explaining to me so well. Best wishes to you and shall keep in touch. X
Just reread my reply to you, and I would like to add a couple of other interesting points. You asked whether I was diagnosed after or before giving birth. As I mentioned, it was not until 1967 - 7 years after Isabel was born - that I was finally diagnosed. But the first symptoms started three months after the birth. Well, there are several theories about what triggers off the disease.
They all seem to be connected with different stages of life: after giving birth, adolescence and the menopause - which gives rise to the cause being connected with hormones. But men are not strangers to rheumatoid disease - although far fewer men are affected. This is accounted for by the fact that men can contract the disease via. the female line - whether from their mothers or further back in the family. But, from what I’ve read men can’t transmit the disease to their offspring. Whether all this is now discounted, I don’t know.
A few years ago, there was an interesting article in the NRAS magazine written by a researcher who put forward the, then, recent research that the causes were mixed and probably from a conspiracy (my word!) between the brain, the immune system and nervous system. And there is also the role played by stress - and the stress doesn’t have to be recent as the effects of stress can be carried forward and even half-forgotten by the time of diagnosis.
All fascinating theories - but we still wait for the BIG breakthrough!
Thanks Bienassis, yes interesting, hormones could be connected. A few females I know with RA contracted either teen years, after baby, a big stress, sometimes flu type illness and menopause. Quite a few I know have sickle cell trait. So hoping for breakthrough one day.
OMG prepping for a colonoscopy is not going well ...,
anyone heard of Purines being a possible trigger for flares? (warning - turkey is high in purines)
Psoriatic arthritis /osteoarthritis .. wondering if anyone can help me, I've been on methotrexate 15mg for 11 weeks
Methotrexate Struggles
A day in the life of someone with RA
