Could folic acid fortication of food affect patients with Rheumatoid Arthritis?




Folic acid is a B vitamin which is found in green, leafy vegetables. Pregnant women are often advised to take folic acid during their pregnancy to reduce the risk of neural tube defects such as spina bifida. Some evidence also suggests that folic acid supplementation may reduce the risks of heart disease, stroke, and cancer. Moreover, some clinical trials have found that low levels of folic acid are associated with clinical depression.

Dietary fortification with folic acid has been used in the United States since 1997 to reduce the risk of neural tube defects in newborn babies.
Rheumatoid arthritis is a debilitating condition which has a world wide distribution with an estimated incidence of 1-2% of the population. Disability is very high amongst patients with rheumatoid arthritis with approximately 60% being unable to work ten years after the onset of the disease. However, folic acid supplementation could theoretically reduce the effectiveness of anti-folate medications such as methotrexate. In fact, a recent study concluded that, "folic acid supplementation may contribute to higher MTX dosing in patients with RA" (Arabelovic et al, 1007).


Arabelovic S, Sam G, Dallal GE, Jacques PF, Selhub J, Rosenberg IH, Roubenoff R. Preliminary evidence shows that folic Acid fortification of the food supply is associated with higher methotrexate dosing in patients with rheumatoid arthritis. J Am Coll Nutr. 2007 Oct;26(5):453-5.

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