Rheumatoid arthritis is an autoimmune disease which means that the immune system of the body attacks the healthy joints instead of attacking foreign substances like bacteria and viruses.
This results in inflammation and pain in the joints and thickening of the tissues that line the inside of the joints.
It is very important to diagnose and treat rheumatoid arthritis at an earlier stage because the thickened tissues can lead to the destruction of bones and cartilage. It can also cause the ligaments and joints to become weak which can make it difficult for a person to perform simple daily activities.
Rheumatoid arthritis occurs mostly in hands and wrists but can also have an effect on other parts of the body. It can decrease the number of red blood cells (anaemia), cause inflammation around the lungs, and around the heart.
It is a symmetrical disease; this means that if one wrist is affected, then the other one will also be affected.
This disease usually begins in the middle age and is more prevalent in older people. However women are most affected by this disease than men are. It is very common among older people in America.
Rheumatoid arthritis is not caused by a single factor. It develops because of interaction of many factors like genetic and environmental factors. Considering this disease is more common among women than men, it can be caused because of hormonal changes during or after pregnancy, during breastfeeding, and by repetitive use of contraceptives.
The common symptoms of rheumatoid arthritis are pain, swelling, and stiffness in the joints. Along with these, some people may also get tired very easily, experience a loss in appetite, and have fever. Inflammation, dryness, and redness can also occur in eyes, mouth, skin, lungs, blood vessels, and blood.
Apart from having detrimental effects on physical health, it can also have an effect on mental health. Some people undergo depression, anxiety, feeling of helplessness and a loss in self-confidence.
There is no permanent cure for rheumatoid arthritis, but if people follow proper medications and therapy, exercise, take an adequate amount of sleep, get vaccinations, and take dietary supplements, then they can have a more promising future.
What is folic acid?
Folic acid is a part of vitamin B complex and is important for the formation of red blood cells. It is also very essential for the synthesis of DNA and RNA within every cell of the body.
Many studies have been conducted which have proven that folic acid can improve brain function and memory, prevent age-related hearing loss, and improve the health of heart.
Consumption of folic acid is necessary in pregnant and breastfeeding women or women who are planning to get pregnant because a lack of folic acid can lead to major birth defects in brain and spine (neural tube defects, spina bifida, and anencephaly) of the unborn baby.
Deficiency of folic acid has several symptoms like fatigue, weight loss, headache, diarrhoea, and heart palpitations.
Green leafy vegetables have a high content of folic acid. Other food items in which folic acid is naturally present are asparagus, broccoli, brussel sprouts, cabbage, lettuce, cauliflower, milk, peas, oranges, sunflower seeds, lentils, papaya, and kiwi.
6 Benefits Of Folic Acid In Rheumatoid Arthritis
Folic acid, a B vitamin, is being recommended in rheumatoid arthritis. Hence this article focuses on the effectiveness of folic acid in rheumatoid arthritis.
1. Folic acid reduces side effects of anti-arthritic drug
Whenever we are talking about the benefits of folic acid in rheumatoid arthritis, it is always put in relation with methotrexate.
Methotrexate is a disease-modifying anti-rheumatoid drug and is most commonly used for the treatment rheumatoid arthritis. It helps in the reduction of pain and inflammation by inhibiting pro-inflammatory chemicals, slows the progressive disease, and also decreased the joint damage.
Methotrexate was initially developed to treat cancer by inhibiting cell growth and preventing their access to folic acid.
A deficiency in folic acid can cause many problems like increased bone marrow toxicity, nausea, abdominal pain, mouth ulcers, liver problems, fatigue, and a reduced red blood cell count. Sometimes these side effects are so intense that people stop taking methotrexate.
Patients with rheumatoid arthritis being treated with methotrexate experience a decrease in the folic acid in the cells.
Hence it is advisable to take folate supplements along with methotrexate to reduce the side effects caused by methotrexate.
What does this mean?
Intake of methotrexate lowers the level of folic acid in the cells. This folate deficiency can lead to many health problems which indicates the necessity of folate supplementation along with methotrexate.
2. Folic acid improves adherence to drug treatment
One might think that the folic acid supplementation might make methotrexate less efficacious in treating rheumatoid arthritis. Many studies have been conducted to test this theory.
A supplementation of folic acid means that a higher dose of methotrexate could be given to patients with rheumatoid arthritis before the side effects are seen.
Considering folic acid supplementation reduces the side effects caused by methotrexate, people could continue taking this drug for treatment for a longer period of time.
What does this mean?
Taking folic supplementation along with methotrexate for rheumatoid arthritis reduces the side effects that methotrexate can cause and also allows you to be treated by the drug for more time.
3. Folic acid reduces heart risk in arthritis
It has been seen that rheumatoid arthritis is linked with cardiovascular disease. There have been incidences in which people with rheumatoid arthritis die of cardiovascular disease rather than by rheumatoid arthritis.
An increase in heart problems in patients with rheumatoid arthritis is linked with an intake of methotrexate. The inhibition of production of folic acid by methotrexate increases the level of amino acid in the blood which causes inflammation in the blood vessels.
This leads to the formation of plaque in the arteries which increases the risk of cardiovascular disease.
What does this mean?
This means that when methotrexate is given alone to treat rheumatoid arthritis, then there is an increase in the occurrence of cardiovascular disease in patients. Folic supplementation with methotrexate protects the patients with rheumatoid arthritis against heart diseases.
4. Folic acid reduces the gastric side effects of methotrexate
A study was conducted to study the efficacy of folic acid in reducing the gastrointestinal side effects caused by methotrexate in rheumatoid arthritis.
There was a 79% decrease in the gastrointestinal toxicity in patients who received folic acid supplementation along with methotrexate. This showed that folic acid has a positive effect in reducing the gastrointestinal side effects caused by methotrexate.
A study was conducted in which it was observed that fewer people suffered from stomach problems when they started taking folate supplementation along with methotrexate.
35 out of 100 people suffered from stomach problems when they took methotrexate alone, however only 25 out of 100 people suffered from stomach problems when they took folic acid along with methotrexate.
In the same study, people were tested for the occurrence of mouth ulcers as a result of methotrexate treatment. It was observed that 6 fewer people suffered from mouth ulcers when they took folic acid supplementation along with methotrexate.
What does this mean?
Patients with rheumatoid arthritis are mostly treated with methotrexate which leads to gastrointestinal toxicity. Folic acid supplementation is given along with methotrexate to reduce the side effects caused by methotrexate.
5. Folic acid reduces the toxicity caused by methotrexate
A study was conducted in which 2 doses (5mg and 27.5mg) of folic acid were used to see their effects on toxicity and efficacy of methotrexate in rheumatoid arthritis.
At the end of the study, it was observed that the dose of folic acid did not affect the efficacy of methotrexate. Also, folic acid supplementation had reduced the overall toxicity scores in patients.
What does this mean?
This means that folic acid is a safe supplement that can be used to protect rheumatoid arthritis patients taking methotrexate as it does not affect the efficacy of the drug and also reduces the overall toxicity caused by the drug.
6. Folic acid reduces the liver toxicity in patients taking methotrexate
A study was conducted to see the effect of folic acid supplementation on liver toxicity caused by methotrexate in rheumatoid arthritis patients.
It was a 48 week trial and at the end of the study period, it was observed that folate supplementation lowers the level of liver enzymes which decreased the rate at which methotrexate was discontinued.
Another study was conducted for the same purpose and a 16% improvement in the occurrence of liver problems was observed in patients who had taken folic acid supplementation.
Also, 21 out of 100 people got abnormal liver tests when they were treated with methotrexate alone. However, only 5 out of 100 people got abnormal liver tests when they took folate along with methotrexate.
What does this mean?
This means that folate supplementation has a positive effect in reducing the liver toxicity caused by methotrexate. It also decreases the rate of discontinuation of methotrexate by people.
Folic Acid for Rheumatoid Arthritis – How to include in the diet?
Folic acid is found in abundance naturally in various sources like; green, leafy vegetables (lettuce, spinach and broccoli), asparagus, okra, beans, fruits (melons, lemons, bananas), yeast, mushrooms, meat (beef kidney and liver), tomato juice and orange juice. In fact now-a-days folate fortified bread, cereals, pasta, crackers and cookies are also available in the market . The recommended dietary allowance (RDA) for folate in DFE is as follows;
- Adults over 13 years of age = 400 micrograms /day
- Pregnant Women = 600 micrograms / day
- Children below 13 years of age = 150 – 300 micrograms /day
Its deficiency might cause Megaloblastic anaemia which is characterized by fatigue, muscle weakness, diarrhoea, nausea and numbness in extremities.
However in case of methotrexate poisoning it is important to supplement folic acid in form of tablets. It must be noted here that artificial supplementation does not mean that we are trying to underestimate the value of natural foods.
In fact patients must be encouraged to include the above mentioned folate rich food in their diet.
Folic Acid for Rheumatoid Arthritis – Dosage
Having understood the importance of folic acid in rheumatoid arthritis, it is very important to know exactly how much folate supplementation should be taken along with methotrexate.
It is best to consult your doctor to find the dosage as some doctors prescribe 1mg of folic acid every day as soon as you take methotrexate whereas some prescribe 1mg folic acid only when the side effects of methotrexate occur.
Experts in rheumatoid arthritis suggest that the recommended dose of folic acid should be 5mg dose once a week but not a day before or after taking methotrexate. It is essential to take the correct dose of folic acid as higher amount are not good for health and can damage the nervous system.
Precautions with Folic Acid
Folic acid is generally safe to take, however sometimes people can experience a few side effects like:
- Loss of appetite
- Difficulty in sleeping
- Bad mouth taste
In very rare cases, a high level of folic acid can lead to the development of colon cancer or rectum cancer. Hence you should always be careful in taking folic acid and always consult a doctor before to attain the maximum health benefits it provides.
An overdose in folic acid has a few side effects like:
- Lack of concentration
Folic acid is an unstable compound which means that it can be easily destroyed by air, light, water, and light. Therefore it is necessary to store the supplements in cold and a dry place.
Also, certain medicines interfere with the absorption of folic acid which can be harmful for the body.
Intake of folic acid should be avoided if you have an allergy; if you have pernicious anaemia (the red blood cell count decreases which makes it difficult for the body to absorb it); or if you have metabolism problems.
Folic acid is an essential vitamin needed for the proper functioning of the body. Hence it is safe for most of the adults. But still some minor considerations must be taken while administering the supplements in high amounts.
These precautionary measures are as follows:
- Research suggests that patients must not take folic acid supplements in high amounts. Doses above 800 mcg may increase the risk for heart attacks among patients with cardiovascular diseases.
- Also high doses of folic acid have been associated with various different side effects like; abdominal cramps, rash, diarrhoea, sleep disturbance, confusion, irritability, nausea, stomach disturbances, seizures, and behavioural changes .
- Too much folic acid hinders zinc absorption in the body .
- It is advisable to limit the consumption of green tea while taking folic acid supplements. It is believed that green tea might interfere with the absorption of folic acid thus leading to folic acid deficiency in the body .
A lot of research has been conducted on the benefits and side effects of methotrexate in treating rheumatoid arthritis. This has increased our understanding on its use and has also helped us find ways to reduce the intensity of the side effects.
Folic acid is an extremely useful compound which should be administered along with methotrexate as it reduces the toxic effects that are caused by methotrexate. Methotrexate decreases the level of folic acid in the body which can increase the risk of many diseases like cardiovascular diseases, gastrointestinal diseases, and liver diseases.
Hence it is important to take folic acid supplementation along with methotrexate to attain the maximum benefits provided by it to treat rheumatoid arthritis.