RESEARCH - Do patients with RA established on MTX and folic acid 5 mg daily need to continue folic acid long term?

August 10, 2006

Rheumatology (Oxford). 2000 Oct;39(10):1102-9.

Comment in:

Rheumatology (Oxford). 2001 Jun;40(6):715-6.

Do patients with rheumatoid arthritis established on methotrexate and folic

acid 5 mg daily need to continue folic acid supplements long term?

Griffith SM, Fisher J, e S, Montgomery B, PW, Saklatvala J, Dawes

PT, Shadforth MF, Hothersall TE, Hassell AB, Hay EM.

Department of Rheumatology, East Surrey Hospital, Surrey, UK.

BACKGROUND: It is postulated that some aspects of methotrexate toxicity may

be related to its action as an anti-folate. Folic acid (FA) is often given

as an adjunct to methotrexate therapy, but there is no conclusive proof that

it decreases the toxicity of methotrexate and there is a theoretical risk

that it may decrease the efficacy of methotrexate. OBJECTIVES: To look at

the effect of stopping FA supplementation in UK rheumatoid arthritis (RA)

patients established on methotrexate <20 mg weekly and FA 5 mg daily, to

report all toxicity (including absolute changes in haematological and liver

enzyme indices) and to report changes in the efficacy of methotrexate.

METHODS: In a prospective, randomized, double-blind, placebo-controlled

study, 75 patients who were established on methotrexate <20 mg weekly and FA

5 mg daily were asked to stop their FA and were randomized to one of two

groups: placebo or FA 5 mg daily. Patients were evaluated for treatment

toxicity and efficacy before entry and then at intervals of 3 months for 1

yr. RESULTS: Overall, 25 (33%) patients concluded the study early, eight

(21%) in the group remaining on FA and 17 (46%) in the placebo group (P =

0.02). Two patients in the placebo group discontinued because of

neutropenia. At 9 months there was an increased incidence of nausea in the

placebo group (45 vs. 7%, P = 0.001). The placebo group had significantly

lower disease activity on a few of the variables measured, but these were

probably not of clinical significance.

CONCLUSIONS: It is important to continue FA supplementation over the long

term in patients on methotrexate and FA in order to prevent them

discontinuing treatment because of mouth ulcers or nausea and vomiting. Our

data suggest that FA supplementation is also helpful in preventing

neutropenia, with very little loss of efficacy of methotrexate.

PMID: 11035130

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve & db=PubMed & list_uids=1\

1035130

Not an MD

I'll tell you where to go!

Mayo Clinic in Rochester

http://www.mayoclinic.org/rochester

s Hopkins Medicine

http://www.hopkinsmedicine.org

August 10, 2006

,

hello my name is Pennie. I am 40, living in Australia and recenetly

diagnoised with a rheumatic disorder, five weeks today, most probably RA, but

still in the diagnosis stage, only had one lot of blood tests yet. I am

wondering if you could resend me the article on fish oil, because I accidently

deleted it, and would like to take it to my doctor in support of my new fish oil

addiction. This site has been very helpful, in these early stages of a very

confusing disease. Thank you to you all.

Pennie

<Matsumura_Clan@...> wrote: