RESEARCH - Folic acid fortification of the food supply associated with higher MTX dosing in patients with RA

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J Am Coll Nutr. 2007 Oct;26(5):453-5.

Preliminary evidence shows that folic acid fortification of the food

supply is associated with higher methotrexate dosing in patients with

rheumatoid arthritis.

Arabelovic S, Sam G, Dallal GE, Jacques PF, Selhub J, Rosenberg IH, Roubenoff R.

US Department of Agriculture Human Nutrition Research Center on Aging

at Tufts University, Boston, Massachusetts 02111, USA.

Abstract

BACKGROUND: Fortification of the diet with folate has been used in the

United States since 1997 to prevent neural tube defects in newborn

babies. However, an increase in dietary folate intake could

theoretically reduce the effectiveness of the anti-folate medication,

methotrexate (MTX) in treating rheumatoid arthritis (RA) and other

inflammatory diseases.

OBJECTIVE: To investigate whether dietary fortification with folic

acid interferes with MTX function in patients with RA.

METHODS: We computed MTX dose per patient per year for the years 1988

to 1999 and plotted these against time, comparing the overall mean MTX

dose before and after 1997, when dietary fortification with folic acid

was instituted in the USA. Thirty-six subjects met eligibility

criteria.

RESULTS: Mean annual MTX dose was stable between 1988 and 1996 (12.4

+/- 4.0mg), but then rose linearly from 1997 to 1999 (16.6 +/- 5.1 mg,

p < 0.001).

CONCLUSIONS: This preliminary study suggests that folic acid

supplementation may contribute to higher MTX dosing in patients with

RA.

PMID: 17914133

http://www.ncbi.nlm.nih.gov/pubmed/17914133

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