Sarah L. Morgan, MD, RD; Graciela S. Alarcón, MD, MPH
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Morgan S., Alarcón G.; Methotrexate in Giant-Cell Arteritis. Ann Intern Med. 2001;135:1006. doi: 10.7326/0003-4819-135-11-200112040-00017
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Published: Ann Intern Med. 2001;135(11):1006.
TO THE EDITOR:
The article by Jover and colleagues (1) on treatment of giant-cell arteritis provides evidence for use of a corticosteroid-sparing agent in elderly women at high risk for complications from long-term corticosteroid use. We would like to clarify that the dosage of folic acid recommended during methotrexate therapy in this study (5 mg/d) is not universally accepted. The authors based this recommendation on work performed by our group at the University of Alabama at Birmingham (2-3), as well as guidelines for the treatment of rheumatoid arthritis from the American College of Rheumatology (4). However, neither the American College of Rheumatology nor our group has recommended the standard use of such a dosage of folic acid. Instead, our data have shown that dosages ranging from 5 to 27.5 mg/wk do not alter the efficacy of methotrexate when used for the treatment of rheumatoid arthritis (2-3). However, to ameliorate the toxicity of methotrexate, as little as 0.4 mg/d (the usual dosage of folic acid in a daily multivitamin) may suffice (2). Even though the higher dosage of folic acid is neither harmful nor expensive, we thought that this clarification was in order.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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