RESEARCH - Folate supplementation and MTX treatment in RA: a review

[Guest guest]

Rheumatology (Oxford). 2004 Mar;43(3):267-71. Epub 2004 Jan 06.

Folate supplementation and methotrexate treatment in rheumatoid

arthritis: a review.

Whittle SL, RA.

Department of Rheumatology, Ashford & St s NHS Trust, St 's

Hospital, Guildford Road, Chertsey, Surrey KT16 0PZ, UK.

OBJECTIVES: The folate antagonist methotrexate (MTX) has become

established as the most commonly used disease-modifying anti-rheumatic

drug (DMARD) in the treatment of rheumatoid arthritis (RA) but is

commonly discontinued due to adverse effects. Adverse effects are

thought to be mediated via folate antagonism. In this paper we summarize

the current data on the use of folates as a supplement to MTX use in RA

for the prevention of adverse effects and as a potential modulator of

cardiovascular risk, and propose guidelines for standard practice.

METHODS: A Medline search was performed using the search terms

" methotrexate " , " folic acid " , " folinic acid " , " folate " and

" homocysteine " . Literature relevant to the use of folates as a

supplement to MTX in the treatment of RA was reviewed and other papers

referred to as references were explored. RESULTS: The use of

supplemental folates, including folic and folinic acid, in RA patients

treated with MTX has been shown to improve continuation rates by

reducing the incidence of liver function test abnormalities and

gastrointestinal intolerance. Folate supplements do not appear to

significantly reduce the effectiveness of MTX in the treatment of RA.

Furthermore, supplemental folic acid offsets the elevation in plasma

homocysteine associated with the use of MTX. This may in turn reduce the

risk of cardiovascular disease, which is over-represented amongst

patients with RA, and for which hyperhomocysteinaemia is now recognized

as an independent risk factor.

CONCLUSIONS: We propose that folic acid supplements be prescribed

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

recommend a pragmatic dosing schedule of 5 mg of oral folic acid given

on the morning following the day of MTX administration.

PMID: 14963199

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve & db=pubmed & dopt=Abstra\

ct & list_uids=14963199 & itool=iconabstr

I'll tell you where to go!

Mayo Clinic in Rochester

http://www.mayoclinic.org/rochester

s Hopkins Medicine

http://www.hopkinsmedicine.org