Efficacy of Methotrexate in Combination with Antioxidant Vitamins (A, C & E) versus Methotrexate alone in the Treatment of Rheumatoid Arthritis

Background:  There is evidence that oxidative stress plays an important role in autoimmune diseases, such as rheumatoid arthritis (RA). Despite the supporting evidence for a beneficial effect of antioxidants on clinical characteristics of RA, the right balance for optimal effectiveness of antioxidants is largely unknown. A study was designed to determine the potential beneficial effects of antioxidant intervention on clinical parameters of RA. Methods:  Randomized clinical trial of 152 patients with positive rheumatoid factor (RF) and a Disease Activity Score (DAS 28) higher than 3.2 were enrolled in the study. Patients were divided into two groups (Group A and Group B) randomly and group A received methotrexate and antioxidant vitamins (A, C and E in a fixed dose) and group B methotrexate only. They were followed up for three visits (baseline, 10 th  week and 14 th  week). The intervention was stopped after 10 weeks and was followed by a ‘wash-out’ period of 4 weeks. At baseline, 10 th  week and 14 th  week patient’s condition were assessed by means of DAS-28 score. P- Value less than <0.05 was considered significant. Results:  The numbers of swollen and tender joints were significantly reduced and general health was improved reflected by improved DAS-28 score at 10 th  week. The antioxidant effect was considered beneficial as compared to the scores of 1 st  visit at baseline; the DAS-28 score was significantly reduced at 2 nd  visit at 10 th  week. Increment of the DAS-28 score among the group A patients who were on antioxidant up to10 weeks, after the “wash-out period” of four weeks i.e. at 14 th  week confirmed a significant relation between changes in clinical condition and antioxidants. Conclusion:  This study was designed to assess the potential beneficial effect of antioxidants (Vitamin A, C and E) in combination with methotrexate in the treatment of RA.