RESEARCH - Folate, homocysteine, and cobalamin status in patients with RA treated with MTX - effect of low dose folic acid supplement

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J Rheumatol. 2004 Dec;31(12):2374-81.

Folate, homocysteine, and cobalamin status in patients with rheumatoid

arthritis treated with methotrexate, and the effect of low dose folic acid

supplement.

Hornung N, Ellingsen T, Stengaard-Pedersen K, Poulsen JH.

Department of Clinical Biochemistry, Randers Central Hospital, Skovlyvej 1,

8900 Randers, Denmark. neh@...

OBJECTIVE: To investigate the effect of methotrexate (MTX) treatment of

rheumatoid arthritis (RA) on folate metabolism, and to determine the effect

of low dose folic acid on toxicity, efficacy, and folate status. METHODS: A

52-week prospective study of 81 patients with RA treated with MTX and

self-administered low dose folic acid; 38 patients were included prior to

MTX therapy, 33 patients continued established MTX therapy, and 10 patients

were excluded. Drug efficacy and side effects were monitored with

biochemical and clinical indicators. RESULTS: MTX treatment resulted in

decreased concentrations of red blood cell (RBC) folate and a rise in plasma

homocysteine. Intracellular concentrations of MTX were inversely correlated

to RBC folate levels after treatment for a longer period (mean 41 months).

Supplement with low dose folic acid prevented or diminished the influence of

MTX on folate status and had a protective effect on MTX induced liver

toxicity without changing the efficacy of MTX. CONCLUSION: MTX interferes

with folate and homocysteine metabolism, and the intracellular concentration

of MTX may play a role. Our results indicate low dose folic acid

supplementation has a beneficial effect on MTX toxicity.

PMID: 15570637

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

5570637

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