Methotrexate and Folic Acid.

[autumnlass]

Hello -

Quick question - does Folic Acid taken x 6 days a week mitigate the side effects of MTX but lose its efficacy as a steroid sparing medicine?

Many thanks

Autumn Lass 🍁

[PMRpro Ambassador]

Not as far as I know. However - MTX isn't always reliable as a steroid-sparer, it works for a small select group of patients and by no means all. Why - are you struggling to reduce the pred despite MTX?

[autumnlass in reply to PMRpro]

I stopped it in March as it was I thought making me breathless on Rheumys instructions . CXR was fine. However I had aqueous shunt on 6 April which failed, and then vitrectomy on May 26. Rheumy said to commence MTX a week later which I did on 1 June. Took dose on 8 June, but 10 June developed chesty cough & put on 5 days of Amox so stopped MTX 15 mg. Chest fine now and restarted last week. 22 June. Perhaps I’m beating myself up as it’s only 4 weeks since vitrectomy and then the chesty cold which lasted 11 days, but feel very weary. Asthenia yesterday and mild neck aches. Not even attempting to taper until next week…perhaps even that’s too soon. The first time I started MTX it worked quite quickly … perhaps I’m expecting miracles!!!

[PMRpro Ambassador in reply to autumnlass]

It isn't unusual for it to be more difficult getting things under control after stopping a medication for some reason. Lord knows why!

[autumnlass in reply to PMRpro]

Thanks Pro! Don’t think vitrectomy and bronchitis intervening helped it’s course!

[PMRpro Ambassador in reply to autumnlass]

Very likely not ...

[Blearyeyed]

Hi, MTX and steroids both deplete Vitamin B 12 and Folate levels because they effect how well we absorb and metabolise these vitamins . The reduced absorption can be worse still if you are also on a PPI and or a statin because of the effect these can have on stomach acids required to break down the B vitamins.The low levels of B 12 and Folates have a knock on effect on how well our whole body works because they are required to help us to metabolise the other nutrients , especially Vitamin D and Iron. This is why people whom often suffer from Anaemia or have anaemia which does not improve after taking iron supplements should have their Vitamin B 12 and Folate levels tested , as , just increasing the iron supplements won't work if the cause for your low iron isn't that you weren't getting enough but that your body didn't have enough B vitamins to process it.

If you have a B 12 or Folate test you should stop taking a supplement containing them for about a week before the test to make sure a recent dose of them doesn't effect how accurate your results are. If you find a deficiency your GP should give you an intrinsic factor blood test to try rule out Pernicious Anaemia before you start any supplements or injections. If you take the supplements for a few months but still have the same symptoms the GP needs to do an active B 12 test , as the original test you will have received will have been a Serum or total B12 test which as the name suggests gives the total B 12 in your system . Your total can be normal but the Active B 12 can be deficient if you aren't metabolising it into the form you can use which means you need B 12 injections just like someone whom is B 12 deficient or has PA.

Folates are generally treated with oral supplements but if your deficiency continues you may need to try liquid forms or infusions.

I personally have B12 and Folate Deficiency Anaemia and receive B 12 injections and liquid Folate to deal with it. The difference in my Fatigue , Muscle numbness and wastage and the pain massively changed as I began my loading doses before them my thighs would literally go heavy and then go to sleep with activity . My tremors stopped and I've felt generally better since.

These deficiencies can cause a large amount of symptoms , especially Fatigue and increased joint pain and inflammation , but it also effects heart function and can cause palpitations and Tachycardia. Circulation and nerve function is also effected causing increased numbness , tingling and blood pooling in your hands and feet. It effects mood and thinking skills and it can cause an increase in headaches, migraines and tinnitus . It can cause breathlessness and effect digestion. It also has a knock on effect on thyroid function and how well you absorb your medications which means that you do not get the full benefit of the dose you are taking. It can cause insulin desensitivity and increase fat distribution to unusual places , reduce muscle mass in arms and legs and causes sweating and chills.

If you do find you have borderline low results but not deficient B 12 or Folate it is worth taking a supplement to prevent the levels decreasing further. It is one of the most overlooked nutritional issues which has a big impact on your life because the GP does not test for these problems early enough.

It should really be recommended to anyone on these drugs, in particular MTX, to take a supplement for B 12 and Folates to prevent this depletion and the effect on how well all of your medications are absorbed in general.

I have a number of friends on MTX for conditions other than PMR, some were advised to take Folates , some Folates and B 12 , others got no advice. They all take Folates and B 12 now. Just remember , as you said , not to take the Folate on the day you take the MTX . Hope that helps, give yourself time you have been through a lot of treatments it will take time for your body to get over it all Bee

[autumnlass in reply to Blearyeyed]

Thank you so much for your very helpful and informative reply. It really has helped.

One thing I have noticed is that starting the MTX again is that the Angular Chelitis has reappeared on the corner of lip. It is sore and painful. The pharmacist recommended clotrimazole? (Canesten) which cleared it coinciding with my stopping MTX for a short while before vitrectomy. Doing a bit of research I see that Vitamin B2 will clear it? Would you know whether that would help? Again many thanks … 🙂