O. Slot, Changes in plasma homocysteine in arthritis patients starting treatment with low-dose methotrexate subsequently supplemented with folic acid, SC J RHEUM, 30(5), 2001, pp. 305-307
In 15 patients with rheumatoid arthritis (RA) (n = 13) or psoriatic arthrit
is (PsA) (n = 2) p-homocysteine and erythrocyte folate (erc-FA) were measur
ed before start of methotrexate (MTX) treatment, after 4 weeks of MTX treat
ment (median 10mg per week), and after further 4 weeks of treatment with MT
X (median 12.5 mg per week) supplemented with folic, acid (FA) (15 mg per w
eek). Mean p-homocysteine were 12.3 +/- 3.4 mu mol/l, 14.6 +/- 5.8 pmol/l (
p < 0.05) and 10.3 +/- 3.0 mu mol/l (p < 0.01) respectively. P-homocysteine
concentrations were negative correlated to ere-FA after 4 weeks (rho -0.58
; p < 0.05). It is concluded that treatment with MTX induces a significant
rise in p-homocysteine that is neutralised by FA supplementation. Supplemen
tation with FA from the start of MTX treatment is recommended considering t
he increased risk of cardiovascular disease that is associated with elevate
d concentrations of p-homocysteine.