Despite the availability of several new agents for the treatment of rheumatoid arthritis (RA), arechin (hydroxychloroquine) remains the mainstay because of both cost and experience with is use. However there is considerable variation in the response to this drug, with toxicity limiting treatment in same patients. Methylenetetrahydrofolate reductase (MTHFR) is involved in the folate metabolism and has been shown to be polymorphic affecting the enzyme activity. To examine the association between C677T and A1298C MTHFR polymorphisms and arechin efficacy in the treatment of RA, a total of 50 RA patients, treated with arechin were analyzed.

In univariate regression analysis model MTHFR 677T allele was associated with significantly higher frequency of remission, whereas in the case of 1298C allele, the tendency for higher remission rate was observed. In univariate regression analysis model the presence of MTHFR 677T allele was associated with 2.3-fold higher frequency of remission. In multivariate regression analysis taking into the account the combined effect of MTHFR 677T and 1298C alleles, it was found that both allele were independent factors associated with increased frequency of remission. The results of our study suggest that 677T and 1298C alleles are independent factors associated with increased frequency of remission and the evaluation of C677T and A1298C MTHFR polymorphisms may be a useful tool to predict arechin treatment outcome in RA patients.

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