Tafazzule Haque Mahmud, Zia Ullah, Azeem Taj, Nadir Zafar Khan, Zafar Iqbal.
Improvement in compliance of patients with Rheumatoid Arthritis to methotrexate by concomitant use of folic acid.
Proceeding Shaikh Zayed Postgrad Med Inst Jan ;15(1):5-10.

Methotrexate is an important and a commonly prescribed second line acrd disease modifirrg drug in the treatment of Rheumatoid Arthritis (RA). It is a folate antagonist through its effect on enzyme dihydro folate reductase. Many patients stop using this medicine clue to its gastrointestinal side effects that occur early in the course of treatment. We performed this study to see if folic acid supplementation can reduce these gastrointestinal side effects thus improving the compliance of patients in the initial period. 133 patients of RA were studies in two groups. Group I (65 patients) received only Methotrexate and Group II (68 patients) were also given Folic acid 5 mg daily for 5 days a week. Both the groups received Methotrexate 7.5 rug per week in two divided doses. Folic acid was given to Group tyro patients on days when they were not using nrethotrexate to avoid an N, possible interactinn that might reduce its efficacy. Patients were followed up for a period of three months. About 48"X, patients in the group I as compared to about 9% in the Group II developed the sick effects. Most common side effects observed were stomatitis, abdominal pain, diarrhoea and vomiting. Comparison of the side effects in the two treatment groups demonstrated statistically significant reduction in the frequency of occurrence in the Group II (P< 0.001). It was interesting to note that patients who dropped out of the study due to these early side effects did so within the first three weeks of the methotrexate therapy. Therefore, it is concluded that folic acid supplementation is an effective way of reducing GI side effects of Methotrexate therapy in Rheumatoid Arthritis and due to this favourable effect, it improves the compliance of these patients to this drug.

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