Folic Acid Supplementation Recommended In Methotrexate Treatment Of Rheumatoid Arthritis

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Folic Acid Supplementation Recommended In Methotrexate Treatment Of

Rheumatoid Arthritis

A DGReview of : " Folate supplementation and methotrexate treatment in

rheumatoid arthritis: a review "

Rheumatology

01/21/2004

By Jill

Folic acid supplementation in patients with rheumatoid arthritis (RA)

treated with methotrexate (MTX) improves tolerability, does not compromise

efficacy, and may reduce the risk of cardiovascular disease, according to a

British study.

MTX is the most commonly used disease-modifying anti-rheumatic drug (DMARD)

in RA treatment. However, there is a 30% probability of MTX discontinuation

1 year after initiation of therapy, with side effects being the main

influencing factor.

Some of these side effects, including gastrointestinal intolerance,

cytopaenias and alopecia, are similar to those seen during folate

deficiency. Moreover, folate deficiency is a recognised risk factor for MTX

toxicity.

Researchers S. I. Whittle and Dr. Rod A. of the Department of

Rheumatology, Ashford & St s NHS Trust, Chertsey, performed a review

summarising current data regarding the use of supplemental folic acid in MTX

therapy for RA to prevent adverse effects and potentially modulate

cardiovascular risk.

Relevant literature was identified by Medline search and reviewed. Results

showed that the use of supplemental folates, including folic and folinic

acid, in RA patients treated with MTX improves continuation rates by

reducing the incidence of liver function test abnormalities and

gastrointestinal intolerance.

Furthermore, supplemental folic acid offsets the elevation in plasma

homocysteine associated with the use of MTX, which may in turn reduce the

risk of cardiovascular disease.

Folic acid supplementation has not been shown to compromise the MTX efficacy

in the treatment of RA. Alternatively, evidence suggests that under some

circumstances, folinic acid may reduce MTX efficacy.

The investigators conclude by proposing that folic acid supplements be

prescribed routinely to all patients receiving MTX for the treatment of RA.

" We recommend a single dose of 5mg of folic acid once per week, taken on the

morning following the day of MTX dosing, " they said. " If adverse effects

still occur, an increase to a single dose of 10 mg per week may be

considered. "

Rheumatology (Oxford) 2004 Jan 6;