Folic Acid and RA

In the world of rheumatoid arthritis, the subject of folic acid is forever tied to methotrexate. A discussion of one is incomplete without the other. In searching the medical literature for articles related to ‘rheumatoid arthritis and folate (folic acid)’, I discovered that most of the titles of the articles include mention of methotrexate.

Are folic acid and folinic acid effective against methotrexate side effects in RA patients?

Yes, according to the Cochrane Review updated in 2013 that included six randomized controlled trials involving 624 RA patients taking MTX (≤ 25 mg/week), of whom 385 also took low-dose folic acid (≤ 7 mg/week). Studies using higher doses of folic acid were excluded because the high dose is no longer recommended or used in clinical practice.

For patients supplemented with either folic or folinic acid while receiving MTX therapy for RA, a 26% relative (9% absolute) risk reduction was seen for the incidence of gastrointestinal side effects such as nausea, vomiting, or abdominal pain. Folic and folinic acid also appear to be protective against abnormal serum transaminase (liver enzyme) elevation caused by MTX, with a 76.9% relative (16% absolute) risk reduction, as well as reducing patient withdrawal from MTX for any reason by 60.8% relative (15.2% absolute) risk reduction.

Importantly, there was no significant reduction in MTX efficacy, as measured by disease activity measures such as tender and swollen joint counts or physician's global assessment scores.

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Folic Acid Use in Rheumatoid Arthritis

Importance of Folic Acid

Folic Acid Awareness Week was January 6-12, 2013 sponsored by the National Council on Folic Awareness (NCFA), a partnership of national organizations, associations, and state folic acid councils. The Center for Disease Control and Prevention (CDC) and the National Council on Folic Awareness emphasize that adequate folic acid intake is important for the prevention of birth defects.

As a person living with RA, I am aware of the importance of taking folic acid to help prevent some of the negative side-effects of methotrexate.  As a new bride, I am impressed with a simple effort by the county to raise awareness of the importance of folic acid in healthy pregnancies.

When Rob and I went to the county courthouse to apply for our marriage license, we received a large folder containing the information and paperwork required in the Commonwealth of Virginia to get married.  One brochure enclosed in our folder provided by Fairfax County focused on the importance of folic acid intake for every woman of childbearing age.

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Folic Acid: Important for RA and for Mothers