Association of Plasma Homocysteine Level and Carotid Intima-Media Thickness in Rheumatoid Arthritis Patients Receiving Methotrexate

Abstract

Objectives:This study aims to evaluate the relationship between serum homocysteine levels and atherosclerotic plaques in carotid arteries in female patients with rheumatoid arthritis (RA). Patients and methods: Fifty-eight females with RA (mean age 45.50±11.69 years; range 42 to 60 years) and 22 female controls (mean age 47.3±8.9 years; range 38 to 62 years) with mechanical low back pain were included in the study. RA patients were divided into two groups: patients who were under methotrexate (MTX) therapy at least for two years (MTX group, n=32), and patients who did not receive MTX at least for past two years (non-MTX-disease-modifying antirheumatic drug group, n=26). RA patients' disease activity scores in 28 joints were calculated. Carotid intima-media thickness and presence of atherosclerotic plaque were evaluated by high-resolution B-mode ultrasonography. Results: Plasma homocysteine levels were higher in MTX and non-MTX-disease-modifying antirheumatic drug groups compared to controls (16.88±6.84 and 10.37±2.54 μmol/L, respectively) and the difference was statistically significant (p=0.001). In MTX, non-MTX-disease-modifying antirheumatic drug and control groups, atherosclerotic plaque was detected in 11 (34.5%) and four (15.4%) patients, and one patient (4.5%), respectively. Carotid intima-media thickness was significantly higher in MTX group compared to other two groups and the difference was statistically significant (p=0.002). Pearson correlation analysis revealed a significant correlation between intima-media thickness and homocysteine levels in MTX group (r=0.49, p=0.006). Conclusion: According to our study results, methotrexate treatment in female patients with RA increases plasma homocysteine levels and prevalence of atherosclerotic plaque. High homocysteine levels in these patients may be a cause of atherosclerosis.

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Atherosclerosis at Extracranial Carotid Vessels and Serum Homocysteine

“…An increase in homocysteine level was significantly associated with an increase in CIMT carotid intima-media thickness [104]. In a study on the patients with primary hypertension, serum homocysteine level was independently associated with CIMT [105].…”

Influence of anti‑TNF therapy and homocysteine level on carotid intima‑media thickness in rheumatoid arthritis patients

“…Rheumatoid arthritis (RA) is a chronic inflammatory systemic disease predisposing to atherosclerosis and high cardiovascular risk (1,2). As a rule, chronic inflammation has a major role in the pathogenesis of atherosclerosis which is characterized by increased mortality.…”

“…Hcy, at high concentrations, becomes harmful to endothelial cells, with atherosclerotic and prothrombotic effects (2). Several studies suggest that increased levels of Hcy in plasma are associated with higher cardiovascular mortality, cerebrovascular accidents, dementia, and bone fracture, but more likely Hcy is considered a marker and not the cause for these diseases (16)(17)(18)(19).…”