Folic acid supplementation prevents deficient blood folate levels and hyperhomocysteinemia

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J Rheumatol. 1998 Mar;25(3):441-6.

Folic acid supplementation prevents deficient blood folate levels and

hyperhomocysteinemia during longterm, low dose methotrexate therapy for

rheumatoid arthritis: implications for cardiovascular disease

prevention.

SL, Baggott JE, Lee JY, Alarcon GS.

Department of Nutrition Sciences, School of Medicine, University of

Alabama at Birmingham, USA. slmorgan@...

OBJECTIVE: To determine the effect of longterm methotrexate (MTX)

therapy and folic acid supplementation on folate nutriture and

homocysteine levels in patients with rheumatoid arthritis. METHODS: A

double blind, placebo controlled trial lasting one year was conducted at

one academic medical center. A total of 79 patients taking low dose MTX

were followed up to one year. The patients were randomized to receive

placebo or 5 or 27.5 mg folic acid supplementation per week. RESULTS:

Plasma and erythrocyte folate levels and plasma homocysteine levels were

determined. The folate nutriture of patients taking low dose MTX

declined without folic acid supplementation. Plasma homocysteine levels

increased significantly over a one year period in the placebo group. Low

folate nutriture and hyperhomocysteinemia occurred with greater

frequency in the placebo group than in the folic acid supplemented

groups.

CONCLUSION: For longterm, low dose MTX therapy, there are now at least 3

reasons to consider supplementation with folic acid (a low cost

prescription): (1) to prevent MTX toxicity, (2) to prevent or treat

folate deficiency, and (3) to prevent hyperhomocysteinemia, considered

by many investigators to be a risk factor for cardiovascular disease.

PMID: 9517760

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