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Updated: Jun 7, 2026

An Immunohistopathologic Study to Profile the Folate Receptor Beta Macrophage and Vascular Immune Microenvironment in Giant Cell Arteritis
Published on: February 8, 2019
Folate supplementation during methotrexate therapy for rheumatoid arthritis.
1Schools of Health Professions, Medicine, and Dentistry, Birmingham, AL 35294-1270, USA. slmorgan@uab.edu
Folic acid (FA) and folinic acid (FLN) supplements can reduce methotrexate (MTX) toxicity in rheumatoid arthritis (RA). FA may also improve MTX efficacy by aiding homocysteine metabolism and preventing 7-hydroxy-MTX formation, at a lower cost than FLN.
Area of Science:
- Rheumatology
- Pharmacology
- Clinical Nutrition
Background:
- Methotrexate (MTX) is a primary treatment for rheumatoid arthritis (RA).
- Folic acid (FA) and folinic acid (FLN) supplements are used to mitigate MTX toxicity.
- The impact of folate supplementation on MTX efficacy requires further investigation.
Purpose of the Study:
- To review clinical trials on folate supplementation in MTX-treated RA patients.
- To evaluate the effect of FA and FLN on MTX toxicity and efficacy.
- To compare the cost-effectiveness of FA versus FLN supplements.
Main Methods:
- Literature review of clinical trials.
- Analysis of studies investigating folate supplementation during MTX therapy for RA.
- Comparison of FA and FLN effects on MTX-related outcomes.
Main Results:
- Both FA and FLN reduce MTX toxicity in RA.
- FA may enhance MTX efficacy by improving homocysteine metabolism.
- FA supplementation may prevent the formation of 7-hydroxy-MTX, a less effective metabolite.
Conclusions:
- Folate supplementation is beneficial in reducing MTX toxicity for RA patients.
- FA supplementation offers a cost-effective option with potential benefits for MTX efficacy.
- Further research is warranted to fully elucidate the impact of folate on MTX efficacy in RA.
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