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Hyperhomocysteinaemia in Behçet's disease
1Division of Rheumatology, Department of Internal Medicine, Ege University School of Medicine, Bornova, Izmir, Turkey.
Insights
Hyperhomocysteinaemia is a significant risk factor for venous thrombosis in Behçet's disease (BD). This correctable condition may offer new strategies for preventing thrombosis in BD patients.
Area of Science:
- Vascular Medicine
- Rheumatology
- Clinical Biochemistry
Background:
- Behçet's disease (BD) is characterized by arterial and venous thrombosis.
- The exact pathogenesis of thrombosis in BD remains unclear.
- Hyperhomocysteinaemia is a known risk factor for thrombosis.
Purpose of the Study:
- To investigate if hyperhomocysteinaemia contributes to arterial and venous thrombosis in Behçet's disease.
- To compare homocysteine levels in BD patients with and without a history of thrombosis against healthy controls.
Main Methods:
- Eighty-four BD patients and 36 healthy controls were enrolled.
- Plasma homocysteine levels were measured using high-performance liquid chromatography.
- Patients with conditions affecting homocysteine levels or on methotrexate were excluded or analyzed separately.
Main Results:
- BD patients exhibited significantly higher plasma homocysteine levels than healthy controls (11.5 vs. 8.8 micromol/l).
- Hyperhomocysteinaemia was present in 64% of BD patients with thrombosis history versus 9% without.
- Methotrexate-treated patients showed the highest homocysteine concentrations.
Conclusions:
- Hyperhomocysteinaemia is identified as an independent risk factor for venous thrombosis in Behçet's disease.
- Unlike genetic factors, hyperhomocysteinaemia is a modifiable risk factor.
- This finding suggests potential new approaches for thrombosis prophylaxis in BD.
Objective:
Arterial and venous thrombosis are among the clinical features of Behçet's disease (BD), the pathogenesis of which is not completely understood. In this study, we investigated whether hyperhomocysteinaemia, being a well known risk factor for thrombosis, is also a contributive risk factor for the arterial and venous thrombosis of BD.
Methods:
Eighty-four patients fulfilling the criteria of the International Study Group for Behçet's Disease (54 males, 30 females, mean age 36+/-9 yr) were enrolled. All the patients were carefully screened for a history of venous thrombosis and were separated into two groups with respect to thrombosis history. Thirty-six healthy individuals (23 males, 13 females), matched for age and sex with the BD group, were included as a negative control group. Patients were excluded if they had any condition that might affect plasma homocysteine concentration. As methotrexate (MTX) causes hyperhomocysteinaemia, we also included 29 rheumatoid arthritis patients (five males, 24 females) receiving MTX weekly. Fasting plasma homocysteine concentrations were measured by high-performance liquid chromatography. The data were analysed with the chi(2) test and Student's t-test.
Results:
The highest homocysteine concentrations were found in the MTX group (17.5+/-5.3 micromol/l). Mean plasma homocysteine concentrations in BD patients were significantly higher than in the healthy controls (11.5+/-5.3 vs. 8.8+/-3.1 micromol/l, P<0.001). Among BD patients with a history of thrombosis, 20 of 31 (64%) had hyperhomocysteinaemia, and this was significantly higher than in those without thrombosis (9%). On the other hand, there was no significant difference between patients with non-thrombotic BD and healthy controls (P>0.05). In patients with thrombosis, we found no correlation between the duration of the post-thrombotic period and homocysteine concentration. Among all the variables investigated, only hyperhomocysteinaemia was found to be related to thrombosis.
Conclusion:
Hyperhomocysteinaemia may be assumed to be an independent risk factor for venous thrombosis in BD. Unlike the factor V Leiden mutation, hyperhomocysteinaemia is a correctable risk factor. This finding might lead to new avenues in the prophylaxis of thrombosis in BD.