Hi - the increase in folic so far to 4 tablets per week seems to be working because despite the raise in dose of Metoject I'm not feeling nearly as sick as I felt on the lower dose of MTX for the previous few weeks. I inject on Tuesday evenings and then take a folic tablet on Thursday,Friday,Saturday and Sunday as instructed.
I was trying to work out why different dosages are recommended for each of us and I found this on RA Warrior: "A small study (22 patients) showed that methotrexate is less effective at controlling psoriasis when folic acid is added. The folic acid dose in that study was 5 mg. daily, which is higher than the highest dose in the larger study previously mentioned. Conflicting results like these have prevented the formulation of a recognized guideline for all patients taking methotrexate for Rheumatoid Arthritis or other autoimmune disease. However, the consensus seems to be in favor folic acid supplementation since it is almost universal. Perhaps it will be determined that it is best to use as little folic acid as is necessary to counter methotrexate side effects."
Could this explain why, when I was taking 4 or 5 folic tabs last year while still on oral MTX, I was low on side effects but my ESR was still high and disease wasn't as well controlled? How does this work? I mean if we are advised to take more MTX but then have to be prescribed a higher folic acid intake to prevent nausea - and if the disruption of foliate absorption is what the MTX depends on in order to modify the disease - then surely this is a bit nuts? Why couldn't I just take a lower dose of injectable MTX with less folic and get the same results? I'm so baffled - can anyone explain?