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Is Folic Acid Good For Rheumatoid Arthritis

Folic Acid Reduces Side Effects Of The Anti

Methotrexate (Rheumatoid Arthritis Drug)

Whenever we are talking about the benefits of folic acid in rheumatoid arthritis, it is always put in relation with methotrexate.

Methotrexate is a disease-modifying anti-rheumatoid drug and is most commonly used for the treatment of rheumatoid arthritis.

It helps in the reduction of pain and inflammation by inhibiting pro-inflammatory chemicals, slows the progressive disease, and also the joint damage.

Methotrexate was initially developed to treat cancer by inhibiting cell growth and preventing their access to folic acid.

A deficiency in folic acid can cause many problems like increased bone marrow toxicity, nausea, abdominal pain, mouth ulcers, liver problems, fatigue, and a reduced red blood cell count. Sometimes these side effects are so intense that people stop taking methotrexate.

Patients with rheumatoid arthritis being treated with methotrexate experience a decrease in the folic acid in the cells.

Hence it is advisable to take folate supplements along with methotrexate to reduce the side effects caused by methotrexate.

What does this mean? Intake of methotrexate lowers the level of folic acid in the cells. This folate deficiency can lead to many health problems which indicates the necessity of folate supplementation along with methotrexate.

Does Folic Acid Really Help Reduce Methotrexate Side Effects

Yes. In 2013, a Cochrane review of six studies found that taking folic acid or folinic acid reduced the proportion of people on methotrexte experiencing stomach problems , abnormal liver tests , and mouth sores .

Overall, fewer people dropped out of methotrexate treatment studies if they used folic acid than if they did not .

How To Reduce Sides Effects

Learn more about how methotrexate affects folic acid, as well as about the other possible side effects.

How does methotrexate affect folic acid?

Folic acid is a B vitamin.

An enzyme in the liver converts folic acid into folate, which plays many essential roles in the body, including helping with cell division and DNA replication.

Methotrexate works by reducing the amount of folic acid in the body, which means that harmful cells cannot replicate.

Taking folic acid

You may be prescribed folic acid tablets while taking methotrexate, a manufactured version of vitamin B9 . Folic acid helps protect the healthy cells in your body and reduces some of the side effects of methotrexate.

You may be wary of the side effects of methotrexate.

A drop in white blood cells could cause infectionsa dip in the production of blood platelets, which could cause abnormal bleeding. Still, most people tolerate the drug quite well, especially if they take folic acid, follow doctors instructions and practice other good health habits.

The only way to reduce the side-effect is to reduce the dose of the drug. However, taking folic acid on non-methotrexate days usually helps with the other side effects. If youre currently on folic acid just once a week, it might be worth taking it on the six non-methotrexate days.

In addition to taking folic acid supplements, a person can also reduce the side effects of methotrexate by talking to a doctor about dosage.

Dosage

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Effect Of Folic Or Folinic Acid On Disease Activity

No statistically significant difference in disease activity was observed between placebo and folic or folinic acid at low dosages. There was a weak signal for an increased number of tender joints in patients treated with folic acid , and both tender and swollen joints for folinic acid , and +1.72 swollen joints per patient however, the wide CI suggest that this is likely due to chance. The mean differences in disease activity between placebo and folate supplementation were analyzed. There was no evidence of a reduction in the mean differences in disease activity in the folate supplementation groups compared to placebo.

Surgery And Other Procedures

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If a joint is severely affected, you may need surgery. The most successful surgeries are those on the knees and hips.

Sometimes people with RA need total joint replacement with an artificial joint. Surgeries may relieve pain, correct deformities, and modestly improve joint function. In some cases, total knee or hip replacement can restore mobility and improve quality of life.

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Doses For Inflammatory Conditions

For inflammatory conditions such as psoriasis, rheumatoid arthritis and Crohn’s disease, the dose will vary. This depends on your condition and blood test results. Always follow the instructions from your doctor.

For rheumatoid arthritis, the usual starting dose is 7.5mg, taken once a week. This can be slowly increased up to 20mg or 25mg once a week.

For psoriasis, the usual starting dose is 2.5mg to 10mg, taken once a week. It can be slowly increased up to 30mg once a week.

For Crohn’s disease, the usual dose to prevent flare-ups is 10mg to 25mg, taken once a week. This is often called a “maintenance” dose.

If your child is prescribed methotrexate, the doctor will use their height and weight to work out the right dose.

Cautions With Other Medicines

There are many medicines that affect the way methotrexate works.

Children taking methotrexate must not have a “live” flu vaccine . Adults are given an “inactivated” flu vaccine and this usually does not cause problems with methotrexate.

Tell your doctor if you’re taking these medicines before you start methotrexate:

These are not all the medicines that may affect methotrexate.

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A New Study Ties Low Folic Acid Levels To A Higher Risk Of Dying From Heart Disease Among People With Ra

Folic acid, the man-made version of the B vitamin folate, is well-known for preventing birth defects, which is why youll find it in prenatal vitamins. But pregnant women arent the only ones who might be dangerously lacking in this important nutrient.

People with autoimmune conditions, including rheumatoid arthritis , are often deficient in folate. Now a new study suggests that RA patients who dont have enough in their bloodstream might be more apt to die from cardiovascular disease.

The new research, which was published in the journal JAMA Network Open, doesnt prove that that folic acid supplements could help prevent a serious cardiovascular event like a heart attack or stroke, though older research hints at that possibility .

In the current study, researchers examined the folate levels of 683 people with RA to see if there was a link to cardiovascular disease-related mortality. They determined that those with the most folate in their blood were 56 percent less likely to die from cardiovascular disease compared to those with the lowest levels .

People who fell in the middle with levels between 4.3 and 8.2 ng/mL also fared fairly well they had a 48 percent lower risk of cardiovascular mortality compared to those in the bottom group. For all groups, researchers adjusted for possible confounders including body mass index, C-reactive protein level, and smoking status.

How To Cope With Side Effects Of Methotrexate

Pharmacology 242 b Methotrexate Folate Antagonist Rheumatoid Arthritis Immunosupressant

What to do about:

  • loss of appetite, feeling or being sick, stomach ache or indigestion eat simple meals and do not eat rich or spicy food. It can help to eat and drink slowly and have smaller, more frequent meals. If youre being sick, try taking small, frequent sips of water to avoid dehydration. For stomach ache, putting a heat pad or covered hot water bottle on your stomach may help.
  • diarrhoea drink lots of fluids, such as water or squash, to avoid dehydration. Signs of dehydration include peeing less than usual or having dark strong-smelling pee. Do not take any other medicines to treat diarrhoea without speaking to a pharmacist or doctor.
  • headaches, feeling tired or drowsy rest and drink plenty of water. Do not take non-steroidal anti-inflammatories, such as ibuprofen. You can try a painkiller such as paracetamol. Do not drink too much alcohol. Do not drive, cycle or use machinery if you feel tired or drowsy. Speak to your doctor if this does not get better.
  • hair loss this is unlikely to be permanent. If hair loss bothers you, talk to your doctor. They may be able to lower your dose or recommend a different medicine.

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Folic Acid Reduces Heart Risk In Arthritis

It has been seen that rheumatoid arthritis is linked with cardiovascular disease.

There have been incidences in which people with rheumatoid arthritis die of cardiovascular disease rather than by rheumatoid arthritis.

An increase in heart problems in patients with rheumatoid arthritis is linked with an intake of methotrexate.

The inhibition of production of folic acid by methotrexate increases the level of amino acid in the blood which causes inflammation in the blood vessels.

This leads to the formation of plaque in the arteries which increases the risk of cardiovascular disease.

What does this mean? This means that when methotrexate is given alone to treat rheumatoid arthritis, then there is an increase in the occurrence of cardiovascular disease in patients. Folic supplementation with methotrexate protects the patients with rheumatoid arthritis against heart diseases.

Mechanism Of Action Of Mtx And Response Predictions

Despite the key role of MTX in current RA therapies, the mechanism of action remains elusive . In part, this may be associated with the fact that MTX may elicit differential effects on various types of immune cells. Conceivably, a primary effect of MTX is mediated via targeting of the folate metabolic pathway that regulates MTX/folate cellular pharmacology . The magnitude of an effect will depend on functional activity of cellular uptake and efflux routes as well as intracellular metabolism to polyglutamate forms. MTX-PG forms have been identified to inhibit a key enzyme in purine biosynthesis de novo, 5-aminoimidazole-4-carboxamide ribonucleotide formyltransferase , promotes release of the endogenous anti-inflammatory mediator adenosine . MTX has also been shown to exert additional pharmacological activities , among which generation of reactive oxygen species, induction of T cell apoptosis and NFB inhibition, of which each contribution in therapeutic efficacy has not been established.

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Nutrition And Dietary Supplements

For anyone with a chronic illness, eating a healthy diet high in antioxidant-rich foods, fruits and vegetables, is essential. Eating a poor diet may increase inflammation in the body.

Also, people with RA are at higher risk of developing heart disease and diabetes. A healthy diet and regular exercise can lower that risk.

Although diet cannot cure RA, studies show that people with RA report less pain, stiffness, and fatigue when they switched from a typical Western diet to a Mediterranean diet that is high in fruits, vegetables, beans, nuts, seeds, fish, and olive oil, and low in red meat. Other studies link a vegan diet, with lots of uncooked berries, fruits, vegetables, nuts, roots, seeds, and sprouts with reduced RA symptoms. Vegan diets contain no animal products and get protein from vegetable sources.

Some people think food allergies play a part in the inflammation common in RA, and say their symptoms get worse after they eat certain foods. Although researchers are not sure if food allergies are to blame, you may want to try an elimination diet, which removes certain foods from your diet and then adds them back, one by one. You will need to keep track of your symptoms in a food diary. Usually it’s best to try an elimination diet under the supervision of your doctor or a registered dietitian.

These general nutritional tips can help you eat a healthy diet:

These supplements may help relieve inflammation and pain:

How Much Folic Acid To Take With Methotrexate

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A doctor will recommend how much folic acid to take and when to take it.

According to the Arthritis Foundation, some doctors suggest taking 1 milligram of folic acid a day. Other research indicates that a once-weekly dose of 5 mg will suffice.

Some people will take the folic acid supplement 24 hours after taking a methotrexate dose.

Because methotrexate also depletes folic acid levels, it can cause a variety of side effects, including:

Taking a folic acid supplement can reduce the risk of these side effects.

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Folic Acid Reduces The Toxicity Caused By Methotrexate

A study was conducted in which 2 doses of folic acid were used to see their effects on toxicity and efficacy of methotrexate in rheumatoid arthritis.

At the end of the study, it was observed that the dose of folic acid did not affect the efficacy of methotrexate. Also, folic acid supplementation had reduced the overall toxicity scoresin patients.

What does this mean? This means that folic acid is a safe supplement that can be used to protect rheumatoid arthritis patients taking methotrexate as it does not affect the efficacy of the drug and also reduces the overall toxicity caused by the drug.

Grading Of Evidence And Summary Of Findings Tables

Major outcomes were presented in summary of findings tables, which provide information on the quality of evidence and the magnitude of the intervention effect, as well as a summary of the main outcome data. The Grading of Recommendations Assessment, Development, and Evaluation working group approach was used to assess the quality of evidence per outcome as outlined in the Cochrane Handbook for Systematic Reviews of Interventions.

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Mixing Methotrexate With Herbal Remedies And Supplements

Do not take vitamin and mineral supplements or any other products that contain folic acid if you are already taking folic acid prescribed by your doctor. Check the ingredients on the labels of any supplements.

There is not enough information to say whether it’s safe to take other herbal remedies or supplements together with methotrexate. They are not tested in the same way as medicines.

Folic Acid Improves Adherence To Drug Treatment

Arthritis treatment: Methotrexate and folic acid

One might think that the folic acid supplementation might make methotrexate less efficacious in treating rheumatoid arthritis.

Many studies have been conducted to test this theory.

Supplementation of folic acid means that a higher dose of methotrexate could be given to patients with rheumatoid arthritis before the side effects are seen.

Considering folic acid supplementation reduces the side effects caused by methotrexate, people could continue taking this drug for treatment for a longer period of time.

What does this mean? Taking folic supplementation along with methotrexate for rheumatoid arthritis reduces the side effects that methotrexate can cause and also allows you to be treated by the drug for more time.

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Quality Of The Evidence

A major problem in synthesizing evidence is the lack of uniformity in outcome measures. All studies described themselves as randomized but some did not give details of how the randomization sequence was generated and what precautions were taken in relation to concealment of allocation. We encourage investigators to describe fully the numbers and flow of patients by treatment group throughout the trial and to clearly report the reasons for dropouts for each group. The studies were small, with few events. This metaanalysis was hampered by lack of uniformity in the way these items were reported.

Does Folic Acid Affect How Methotrexate Treats Ra

Taking folic acid with methotrexate doesnt decrease methotrexates effectiveness in treating your RA.

When you use methotrexate to treat RA, it helps decrease pain and swelling by blocking certain chemicals in your body that lead to inflammation. Methotrexate does block folate, but the way it treats RA seems to be mostly unrelated to blocking folate.

Therefore, taking folic acid to make up for the folate you lose from taking methotrexate helps reduce the side effects of folate deficiency without affecting your treatment of RA.

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Why Is My Doctor Recommending That I Take Folic Acid

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Folic acid and folinic acid are forms of vitamin B9, which you need to keep your cells dividing and growing normally. Folic acid is also essential in the production of red blood cells. Methotrexate blocks some of the actions of folic acid, which can lead to side effects such as mouth sores, abdominal pain, liver problems, hair loss, and anemia. For some people, the side effects are bad enough that they stop taking their methotrexate.

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How Does Methotrexate Come

Methotrexate is available as an oral tablet, oral solution, and as an injection. You may only need to take it once per week, so be sure to follow your doctor’s dosing instructions exactly. It comes as a generic option, in brand names and as a prescription or over-the-counter product.

Medical uses vary by the brand names of methotrexate, which include:

Why Is This Medication Prescribed

Methotrexate is in a class of medications called antimetabolites.

It also can suppress the immune system. The drug makes your immune system less active.

Methotrexate treats cancer by slowing the growth of cancer cells. These include breast cancer, lung cancer, some cancers of the head and neck, leukemia, and certain types of lymphoma.

Methotrexate treats psoriasis by slowing the growth of skin cells to stop scales from forming.

Methotrexate may treat rheumatoid arthritis by decreasing the activity of the immune system.

Methotrexate is a medication that doctors prescribe to treat certain conditions, including adult rheumatoid arthritis, some cancers, and severe psoriasis.

Psoriasis is a skin disease that causes red, scaly, itchy patches to form on the body. Methotrexate slows the growth of skin cells which keeps scales from forming.

Methotrexate also can be used to treat Crohns disease, multiple sclerosis, and other autoimmune diseases.

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