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Related Experiment Videos

Reversible optic neuropathy associated with low-dose methotrexate therapy.

Gerry Clare1, Stephen Colley, Robin Kennett

  • 1Oxford Eye Hospital, Radcliffe Infirmary, Woodstock Road, Oxford, OX2 6HE, UK.

Journal of Neuro-Ophthalmology : the Official Journal of the North American Neuro-Ophthalmology Society
|June 7, 2005
PubMed
Summary

Methotrexate use for rheumatoid arthritis can cause optic neuropathy due to low folate levels. Supplementation with folic acid reversed vision loss, suggesting a link between methotrexate, folate deficiency, and optic nerve health.

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Area of Science:

  • Ophthalmology
  • Rheumatology
  • Clinical Toxicology

Background:

  • Methotrexate is a common treatment for rheumatoid arthritis.
  • Methotrexate can inhibit folate metabolism, potentially leading to toxic side effects.
  • Optic neuropathy is a known but rare complication of methotrexate therapy.

Observation:

  • A 66-year-old woman developed progressive bilateral optic neuropathy, including central scotomas and dyschromatopsia.
  • The patient was taking oral methotrexate for rheumatoid arthritis without folic acid supplementation.
  • Low serum folate levels (1.6 ng/mL) were detected, while vitamin B12 levels were normal.

Findings:

  • Discontinuation of methotrexate and oral folic acid supplementation led to complete visual recovery.
  • Serum folate levels normalized with treatment but decreased again after cessation of folic acid.

Related Experiment Videos

  • The patient's persistently low folate levels suggest a possible underlying genetic defect in folate metabolism.

    • Implications:

    • This case suggests a potential link between methotrexate-induced folate deficiency and reversible optic neuropathy.
    • Folic acid supplementation should be considered in patients on methotrexate, especially those with unexplained low folate levels.
    • Further research is needed to definitively establish methotrexate as a cause of reversible optic neuropathy associated with folate deficiency.