Factors associated with hyperhomocysteinaemia in Mexican patients with rheumatoid arthritis.
BACKGROUND
Hyperhomocysteinaemia is a factor related to the development of atherosclerosis in rheumatoid arthritis (RA). However, Hispanics with RA develop high rates of coronary disease; there are no studies about the frequency and factors related to high levels of homocysteine in Mexican patients.


OBJECTIVE
To evaluate the prevalence and characteristics associated with hyperhomocysteinaemia in Mexican patients with RA.


METHODS
One hundred and fifty-two patients with RA were compared with 153 controls. The assessment in RA included clinical characteristics, disease activity (RADAR), functioning (HAQ-Di and global functional status), comorbidity, and radiological damage. Laboratory determinations included total serum homocysteine (tHcy), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), rheumatoid factor (RF), and lipid profile.


RESULTS
Median levels of homocysteine were higher in RA compared with controls (11.3 vs. 9.3, p<0.001). Twenty per cent of the patients with RA had hyperhomocysteinaemia (>15 micromol/L) compared with 6% in controls (p<0.001). There was statistical association between hyperhomocysteinaemia in RA with male gender (p<0.001), impairment in the global functional status (p = 0.004), higher radiological damage (p = 0.001), and CRP (p = 0.04). There was no association with RADAR, HAQ-Di, or RF, methotrexate dose or duration of use. In the adjusted multivariate model, the two variables associated with higher risk for hyperhomocysteinaemia were male gender (OR = 4.2, 95% CI 2 to 12, p = 0.006) and higher radiological damage (III-IV) (OR = 3.4, 95% CI 1.3 to 9, p = 0.01).


CONCLUSIONS
Our data show a high prevalence of hyperhomocysteinaemia in Mexican patients with RA. More effort is required to evaluate and treat earlier this coronary risk factor.
Lopez-Olivo
M A
MA
Department of Internal Medicine, Rheumatology, Hospital General Regional 110, Instituto Mexicano del Seguro Social (IMSS), Guadalajara, Mexico.
Gonzalez-Lopez
L
L
Garcia-Gonzalez
A
A
Villa-Manzano
A I
AI
Cota-Sanchez
A R
AR
Salazar-Paramo
M
M
Varon-Villalpando
E
E
Cardona-Muñoz
E G
EG
Gamez-Nava
J I
JI
D000293:Adolescent; D000328:Adult; D000368:Aged; D001172:Arthritis, Rheumatoid / Q000097:blood / Q000150:complications* / Q000453:epidemiology; D050197:Atherosclerosis / Q000453:epidemiology / Q000209:etiology; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism; D002784:Cholesterol / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D006710:Homocysteine / Q000097:blood*; D006801:Humans; D020138:Hyperhomocysteinemia / Q000097:blood / Q000150:complications / Q000453:epidemiology*; D015994:Incidence; D008297:Male; D008800:Mexico / Q000453:epidemiology; D008875:Middle Aged; D012189:Retrospective Studies; D012217:Rheumatoid Factor / Q000097:blood; D012307:Risk Factors; D012720:Severity of Illness Index
D015415:Biomarkers; D006710:Homocysteine; D002097:C-Reactive Protein; D012217:Rheumatoid Factor; D002784:Cholesterol