Does Folic Acid Fortification of Food Affect Rheumatoid Arthritis?

Does Folic Acid Fortification of Food Affect Rheumatoid Arthritis?

Senior man with 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.

What’s more is that some clinical trials have found that low levels of folic acid are associated with clinical depression.

Neural Tube Defects and Folic Acid:

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.

Folic Acid and Rheumatoid Arthritis:

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.

Methotrexate is not only the first-line medication for RA, but’s its also used as an anchor drug in combination with other medication such as hydrochloroquin.  Patients who take methotrexate are advised to take 5 mg of folic acid to reduce drug-related side effects.

A Recent Study Concluded:

“folic acid supplementation may contribute to higher MTX (methotrexate) dosing in patients with RA(rheumatoid arthritis)” (Arabelovic et al, 1007).

The results of this study are far from definitive in their conclusions.  Regardless, patients are always advised to take folic acid at a dosage of 5mg per day when they’re on MTX to reduce side effects.


  1. 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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