Background Recent reports have suggested that elevated total circulating homocysteine levels are important risk factor for vascular diseases, stroke, and thrombotic events in patients with atherosclerosis and in patients with systemic lupus erythematosus.
Objectives The aim of our study was to analyse the relationship between plasma homocysteine levels and thrombotic events in a select population of rheumatoid arthritis (RA) patients with or without antiphospholipid antibody (aPL) positivity.
Methods 168 female RA patients attending the Extra-articular Involvement RA Clinic of University of Genova and 72 female subjects matched for age and vascular diseases as controls were included in the study. 30 of the RA patients showed aPL antibody positivity and 138 were found aPL antibody negativity on the basis of the concomitant presence or absence of high concentrations of anticardiolipin (aCL) antibodies or presence of Lupus Anticoagulant (LA). All subjects were evaluated for plasma homocysteine concentrations and for the occurrence of thrombotic events.
Results Twenty-five RA patients and five controls reported a history of thrombotic events. Eleven and nine of RA patients with aPL antibody positivity were found previously affected by venous and arterial thrombosis, respectively. Plasma levels of homocysteine in aPL antibody positive patients with thrombosis were found significantly higher than in aPL antibody positive RA patients without thrombosis (p < 0.001). When RA patients with thrombosis were analysed a significant increase of plasma homocysteine levels was found in aPL antibody positive RA patients versus aPL antibody negative RA patients (p < 0.04) and versus related controls (p < 0.003).
Conclusion The association observed between aPL antibody positivity and high levels of plasma homocysteine in RA patients may represent a possible risk factor for thrombotic events. Therefore, it is suggested that hyperhomocysteinemia might be involved in vascular-related mortality observed in RA patients with a history of thrombosis.
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