The increase of homocysteine (Hcy) is an independent risk factor related to the development of atherosclerosis (AS) and the cardiovascular disease (CVD) in patients with rheumatoid arthritis (RA). Cardiovascular disease is a leading cause of mortality in RA. The aim of the study was to determine its relationship with homocysteine and the clinical immunological-inflammatory and metabolic laboratory markers and evaluate the factors in relation to hyperhomocysteinaemia in RA.
Analysis of total serum homocysteine (Hcy) concentrations was carried out in fifty patients with RA compared with 50 matched health controls. In patients with RA, numerous immunological-inflammatory and metabolic laboratory makers included, folate, vitamin B12 complement (i.e. C3 and C4), C-reactive protein (CRP), Rheumatoid factor (RF), anticyclic citrullinated peptide (anti-CCP) antibody, cystatin C (CysC), triglycerides, cholesterol and total leukocyte count. We also assessed imaging makers, common carotid intima-media thickness (IMT) and disease activity makers such as Disease Activity Score in 28 joints (DAS28).
Median concentration of Hcy was significantly greater in patients with RA than in controls: 9.09 (5.38-33.91) vs. 7.45 (4.89-25.77) μmol/L (p<0.001). In RA patients, homocysteine was inversely associated with folate (rho=-0.672, p<0.0001), vitamin B12 (rho=-0.424, p=0.002), C3 (rho=-0.612, p<0.0001), C4 (rho=-0.323, p=0.022), correlate with CRP (rho=0.342, p=0.015), CysC (rho=0.430, p=0.002), but not with anti-CCP antibody (rho=0.205, p=0.152), RF (rho=0.214, p=0.135), triglycerides (rho=-0.107, p=0.459), cholesterol (rho=0.160, p=0.268), total leukocyte count (rho=-0.157, p=0.276), IMT (rho=0.134, p=0.156), DAS28 (rho=0.211, p=0.148). There was association between hyperomocysteinaemia in RA with vitamin B12 (p=0.037), folate (p<0.001), and CRP (p=0.018). There was no association with male gender, anti-CCP antibody, RF, IMT and DAS28.
Results from this study suggested that Hcy concentration was increased in RA patients and associated with RA-related immunological-inflammatory and metabolic laboratory markers, including folate, vitamin B12, CRP, CysC, C3, C4. Early determination of Hcy and correlated clinical laboratory markers may be useful to evaluate RA patients with high cardiovascular risk.