Folic acid, an inexpensive vitamin, is safe in a broad range of doses and protects patients with rheumatoid arthritis who are taking methotrexate from toxicity while preserving the efficacy of methotrexate.

Thirty-two patients with rheumatoid arthritis completed a 24-week, placebo-controlled, double-blind trial of folic acid (FA) supplementation during low-dose methotrexate (MTX) therapy. Administration of the daily FA supplement significantly lowered toxicity scores without affecting efficacy, as measured by joint counts, joint indices, and patient and physician evaluation of disease activity. Fifteen patients experienced some sort of toxicity; 67% were in the placebo group, and 33% were in the FA supplement group. Four patients in the placebo group had toxicity levels serious enough to require discontinuation of the MTX, while no patients in the FA supplement group discontinued MTX because of toxicity. Low-normal initial plasma and red blood cell folate levels were predictive of future toxicity with MTX therapy. We conclude that a daily supplement of 1 mg of FA during low-dose MTX therapy (median dose 7.5 mg/week [16.4 pmoles]) is useful in lessening toxicity without altering efficacy during the first 6 months of treatment.

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Objective. To examine the effectiveness of two telephone intervention strategies for improving the health outcomes of patients with systemic lupus elythema-tosus (SLE). Methods. Fi&-eight SLEpatients were randomlyas-signed to receive a 6-month telephone counseling intervention using either a treatment counseling (TC) or symptom monitoring (SM) strateg. Health outcomes were assessed using the Fatigue Severity Scale (FSS) and the Arthritis Impact Measurement Scales 2 (ALMS2). Results. At the 6-month followup, the mean AIMS2 Physical Function scale and AlMS2 Social Support scale scores were significantly improved (P < 0.05) for the TC group compared to the SM groups. The mean FSS score, AIMS2 Affect score, and AIMS2 Pain score were significantly improved (P < 0.05) for both groups. Conclusions, Telephone interventions, especially using the TC approach, can be effective for improving the functional status of persons with SLE.