AN AUDIT OF METHOTREXATE AND FOLIC-ACID FOR RHEUMATOID-ARTHRITIS - EXPERIENCE FROM A TEACHING CENTER

We describe an audit of 158 patients with RA treated with weekly metho trexate and 5 mg of folic acid 24 h later. Our aim was to assess the s afety and efficacy of this regime in our hands compared with published clinical trials of methotrexate in RA, and to examine patient outcome s. Treatment improved ESR, but only 69% of patients continuing therapy for prolonged periods believed their arthritis to be better on treatm ent. Health Assessment Questionnaire and Hospital Anxiety and Depressi on questionnaire scores in prospectively studied patients were not sig nificantly altered by treatment. Toxicity occurred frequently (59% in those continuing and 89% in those ceasing therapy) and cessation of th erapy solely due to lack of efficacy was rare. The probability of pati ents continuing with methotrexate and folic acid after 1, 2, 3 and 4 y r was 87, 76, 74 and 74%, respectively, figures that are at the upper end of the reported range for methotrexate alone.