Folic Acid Keeps Arthritis Patients on Methotrexate

About two-thirds of patients with rheumatoid arthritis (RA) treated with methotrexate can continue using this drug for at least 5 years, Dutch investigators have found. Adding folic acid and prednisolone to treatment regimens appears to relieve methotrexate’s side effects and thus increase the chances that patients continue taking the drug.

About two-thirds of patients with rheumatoid arthritis (RA) treated with methotrexate can continue using this drug for at least 5 years, Dutch investigators have found. Adding folic acid and prednisolone to treatment regimens appears to relieve methotrexate’s side effects and thus increase the chances that patients continue taking the drug. Rheumatoid arthritis is a chronic disease marked by inflammation in the joints that causes pain, swelling and loss of mobility. It is an autoimmune disease, meaning it arises from an abnormal immune system attack on the body’s own tissue. Methotrexate is the standard drug used to relieve the symptoms and slow the joint damage. Some reports even suggest that methotrexate increases life expectancy in patients with this autoimmune disease. But about 30 percent of patients discontinue treatment early due to toxicity, manifested as stomach upset and abnormal liver enzyme test results, or because the drug is ineffective. Dr. Monique Hoekstra and colleagues from Medisch Spectrum Twente in Enschede, The Netherlands, analyzed data from charts to find out what factors influence the likelihood that patients will continue using methotrexate. The researchers analyzed a total of 1072 methotrexate treatment episodes in 1022 RA patients. They report in the Journal of Rheumatology that 64 percent of patients were still taking methotrexate after 5 years, and that half continued as long as 9 years. Statistical analysis demonstrated that patients taking the vitamin folic acid, the steroid drug prednisolone, or the anti-inflammatory drug sulfasalazine were more likely to continue using methotrexate. In fact, more than twice as many patients who used folic acid were still taking methotrexate after 5 years. “Age, disease duration, body mass index, and creatinine clearance were not related to methotrexate survival,” Hoekstra and colleagues report. (Source: J Rheumatol 2003;30:2325-2329: Reuters Health News: 24th December 2003)