Methotrexate — SCE Rheumatology MCQ

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EasyRheumatology PharmacologyMethotrexateSCE Rheumatology

A patient on Methotrexate 20 mg weekly for RA asks about folic acid. She takes her Methotrexate on Mondays. According to BSR 2025 on which day should she NOT take folic acid?

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Correct answer: A — Monday

BSR 2025 csDMARD guidelines state that folic acid (minimum 5 mg weekly) should NOT be taken on the same day as Methotrexate. Since this patient takes Methotrexate on Monday, Monday is the day to avoid folic acid. This is because folic acid competes with Methotrexate for the same cellular uptake pathways and could theoretically reduce Methotrexate efficacy if taken concurrently. Folic acid can be taken on any other day of the week.

Reference: BSR 2025 - Guideline for prescription and monitoring of conventional synthetic DMARDs