Your specialist team or GP may prescribe certain nutrition supplements because they can be useful in preventing the side effects of medications.

Folic acid

Folic acid supplements may help prevent some of the side effects of methotrexate, a conventional disease modifying anti-rheumatic drug (cDMARD), commonly used in first line management of RA.

The British Society for Rheumatology guidelines recommends a typical folic acid dose of 5mg once weekly, not on the same day as methotrexate (also typically taken once weekly). Folic acid reduces toxic effects and improves continuation of therapy and compliance.

Calcium and vitamin D

Calcium and vitamin D are essential nutrients for bone health and supplements may be prescribed for patients with RA taking glucocorticoids (steroids), which can increase the risk of bone loss and osteoporosis.

Steroids may be offered as a short-term treatment to manage flares in people with recent onset (or established disease) to rapidly decrease inflammation, and to improve symptoms while waiting for a new cDMARD to take effect (which can take 2–3 months).

Although laboratory research has suggested that vitamin D may have anti-inflammatory effects, further studies are needed to better understand the role of vitamin D in inflammatory conditions, and currently there is no evidence that vitamin D supplements are of benefit in RA. Regardless of possible effects on inflammation, it is recommended that all adults take a daily supplement containing 10µg (micrograms) of vitamin D during the autumn and winter months, when the sun is not strong enough for the body to make vitamin D.