As a patient with rheumatoid arthritis, you may be prescribed disease-modifying, anti-rheumatic drugs, or DMARDs. Methotrexate is one such medication commonly used to treat symptoms and slow down the progression of the disease and damage to your joints. Methotrexate can have highly toxic side effects; it has been shown that supplementation of folic acid can reduce these risks.
Folic Acid
Folic acid, or folate, is one of the eight B vitamins and is an essential vitamin for the body. It is a vitamin needed for the creation and function of DNA and the production of new cells throughout the body. According to "The Journal of the American Medical Association," it is a vitamin that is essential to preventing neural tube defects in newborn babies and is prescribed as a supplement for pregnant women. Because of this, many breads and cereals have now been fortified with folic acid. It can also be found naturally in leafy green vegetables, fruits and nuts.
Rheumatoid Arthritis
Rheumatoid arthritis is a progressive autoimmune disease that mostly affects women. Your body's immune system attacks the joints in the body causing inflammation and joint damage. It is a disease that generally attacks both sides of the body equally meaning if one knee is affected, the other likely will be as well. Symptoms can include morning joint stiffness, fatigue, joint pain, a lack of range of motion in the joints and numbness. As the disease progresses, it can result in severe joint damage and deformity. Rheumatoid arthritis is traditionally treated with a combination of DMARDs and nonsteroidal anti-inflammatory drugs, or NSAIDs, such as aspirin and ibuprofen. According to the National Institutes of Health, methotrexate is the most commonly used DMARD in the treatment of rheumatoid arthritis.
Methotrexate
Methotrexate is also a chemotherapy drug, though it is used in low doses for patients with rheumatoid arthritis. Methotrexate can cause serious side effects such as a decrease in blood cells, liver damage, reduced immune system, lung damage, an increased risk of developing lymphoma and even death. According to "The Journal of the American Medical Association," methotrexate can reduce your folate levels in your body, therefore, supplemental folic acid is recommended. Methotrexate can come in pill or injection form.
Medical Research
Numerous studies have examined the connection between folic acid, rheumatoid arthritis and methotrexate. A 2009 study published in "The British Journal of Dermatology" looked at just how effective folic acid supplementation was for rheumatoid arthritis patients on methotrexate. They discovered that folic acid supplementation was able to reduce liver damage caused by methotrexate. A 2005 study published in "Zeitschrift Fur Rheumatologie" concluded that folate supplementation should be prescribed for all patients who are taking methotrexate.
Considerations
If you are a patient who has been prescribed methotrexate for your rheumatoid arthritis treatment, consult your physician regarding folic acid supplementation. Dosages will vary for each patient depending on methotrexate dose. Folic acid supplements can be prescribed or purchased over-the-counter. Your physician will be able to best guide you to the ones that will be most effective for your situation.
References
- "The Journal of the American Medical Association"; Folic Acid; John L. Zeller, MD, PhD; December 13, 2006
- MedlinePlus: Folic Acid
- MedlinePlus; Rheumatoid Arthritis; February 14, 2011
- MedlinePlus; Methotrexate; April 1, 2009
- "The British Journal of Dermatology"; Effect of Folic or Folinic Acid Supplementation on Methotrexate-associated Safety and Efficacy in Inflammatory Disease; S. Prey and C. Paul; March 2009
- "Zeitschrift Fur Rheumatologie"; Reducing Toxicity of Methotrexate With Folic Acid; P. Harten; June 2005
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